Association Between Neurological Outcomes and Timing of Physical Therapy Initiation Among Patients Treated for Aneurysmal Subarachnoid Hemorrhage: A Propensity-Adjusted Analysis

Abstract

BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) is a debilitating neurological disease associated with poor neurological outcomes. OBJECTIVE: To evaluate the association between timing of physical therapy (PT) initiation and neurological outcomes among patients treated for aSAH. METHODS: Patients receiving definitive aneurysm treatment at a single quaternary center (January 1, 2014-July 31, 2019) with data available on PT initiation and the number of sessions were analyzed. Patients were compared based on whether PT initiation was delayed (>24 hours after definitive aneurysm treatment) or nondelayed (≤24 hours after treatment). The primary outcome was a poor neurological outcome at last follow-up (modified Rankin Scale [mRS] score >2). A propensity-adjusted score was generated and included as a covariate in a logistic regression analysis. RESULTS: Among 382 patients, 260 (68%) had delayed and 122 (32%) had nondelayed PT initiation. A significantly greater percentage of patients in the delayed PT group had an mRS score of >2 at last follow-up (42% [n = 110] vs 20% [n = 24]; P < .001). Among 298 patients with a Hunt and Hess (HH) grade <4, the percentage with an mRS score of >2 at last follow-up was significantly higher in the delayed (34% [62/184]) than nondelayed (18% [21/114]) PT group (P = .006). The logistic regression analysis showed that, among patients with an HH grade of <4, delayed PT initiation increased the risk of having an mRS score of >2 at follow-up (odds ratio = 1.90, 95% CI = 1.02-3.62, P = .047). CONCLUSION: Delayed PT initiation after definitive aneurysm treatment was associated with poor neurological outcomes regardless of patient characteristics, neurological presentation, or aneurysm characteristics.