Abstract WP121: Early Mobilization Post Acute Stroke Thrombolysis And/or Thrombectomy (EMPATHY) Survey

Abstract

Background: Traditionally, bed rest after emergency ischemic stroke treatments has been defined as 24 hours hours. The scientific basis for this timeline has not been established and practices may vary. We sought to determine bed rest practices following emergency stroke therapy in centers across the United States. Methods: We surveyed hospitals in the StrokeNet system regarding bed rest practices following acute stroke thrombolysis and/or thrombectomy. An anonymous survey (SurveyMonkey®) was sent out by the central coordinating center to all StrokeNet participating centers across the United States. Survey questions included stroke center designation, location of admission, whether a formal bed rest protocol was in place, minimum bed rest period required, which person first mobilized the patient, average duration of bed rest, which factors would alter duration of bed rest. Results: 48 centers responded to the survey including 45 Comprehensive Stroke Centers and 3 Primary Stroke Centers. Most patients were admitted to a neuro-intensive care unit (69%), and others to a general medical/surgical ICU or stroke ward. 60% of respondents indicated that a formal bed rest policy was in place. Minimum bed rest requirements after thrombolysis alone ranged from 0-24 hours (43% with a 24 hour bed rest protocol, 20% with no minimum, 15% with a 12 hour minimum, 5% with an 8 hour minimum, 5% with a 6 hour minimum, and 12% with an indeterminate response). Similar variations were reported in patients undergoing thrombectomy with ranges from 0-24 hours bed rest. First mobilization was by a nurse 52% of the time and by a physical therapist 48% of the time. Actual mobilizations ranged from 0-36 hours after treatment. The most common factors that altered bed rest duration were: hemodynamic factors (> 90% of respondents depending on the scenario) and NIHSS score (> 65% depending on the scenario). Conclusion: Bed rest practices following emergency ischemic stroke treatment vary significantly across stroke centers. Mobilization of patients is performed primarily by nurses and therapists. Major factors that influence bed rest duration include hemodynamic factors and NIHSS score. Further study regarding an optimal approach for bed rest is warranted.