Abstract TP555: Early Rehabilitation in Aneurysmal Subarachnoid Hemorrhage Patients is Associated With Better Cognitive Outcomes and Shorter ICU Stay

Abstract

Early rehabilitation is associated with improved outcomes in some neurological conditions. Patients with aneurysmal subarachnoid hemorrhage (aSAH) have prolonged ICU and hospital stays with delayed rehabilitation. We aimed to study the effect of early rehabilitation on patient reported outcomes, length of stay in the ICU as well as 90-day physical function and cognition. This was a pilot randomized controlled study of aSAH patients, 10 experimental and 10 controls, with Hunt-Hess grades I - IV, who underwent endovascular embolization or surgical clipping. Demographic, clinical, radiographic and cost characteristics were collected. The experimental group underwent a rehabilitation program on the day after aneurysm repair with increased visits by physical and occupational therapists, increased out-of-bed time, utilization of a bedside ergometer, and a number of cognitive exercises. A 29-question Patient-Reported Outcomes Measurement Information System (PROMIS-29) survey was given to the patient in the week of discharge as well as at 30 and 90 days after discharge. A Montreal Cognitive Assessment (MoCA) was performed at one-week post-ictus, 30 and 90 days. Baseline demographic, clinical and radiological characteristics were similar between both groups and there were no adverse events related to mobilization. Median ICU length of stay was significantly decreased in the experimental group (3.5 vs 10.5 days, p=0.037), as was the overall cost of care. PROMIS-29 results revealed more fatigue in the control group at one week prior to discharge (p=0.026) and more sleep disturbances in the control group at 30-days post discharge (p=0.032). Other PROMIS-29 outcomes of physical function, depression, anxiety, and pain were not different between the groups. Baseline mean MoCA scores were similar, but experimental group had greater improvement at both 30 (+4.6 vs +0.9, p=0.007) and 90 (+5.4 vs +1.8, p=0.031) days. Excellent outcome by modified Rankin Scale scores (0-1) was not significant different between the two groups (90% experimental, 50% controls, p=0.14). Early rehabilitation in aSAH patients is feasible and is associated with shorter ICU stay, less cost and improved cognitive outcomes at 30 and 90 days. A larger study is needed to confirm these findings.