Early Mobilization Of Patients Research Articles

Medical Professionals’ Perspective on Safety and Efficacy of Early Mobilization in Acute Heart Failure Patients

Medical Professionals’ Perspective on Safety and Efficacy of Early Mobilization in Acute Heart Failure Patients

Early mobilization in critically ill pediatric patient with ventilatory support. Experience of a high complexity center

In the pediatric intensive care units (PICU) from our region, early mobilization (EM) in patients requiring ventilatory support is an underreported activity. For this reason, we emphasize the need for epidemiological research that allows us to know the characteristics of this relevant activity in the evolution of critically ill patients. Objective: describe the population, time of onset and frequency which MT is performed in patients who received ventilatory support in a PICU of a public pediatric hospital of Latin America. Materials and methods: descriptive, retrospective, observational study, conducted in a 17-bed medical-surgical PICU of a pediatric hospital in Argentina, between July 1 and December 31, 2019. All patients under 18 years of age requiring invasive mechanical ventilation (IMV) and/or noninvasive mechanical ventilation (NIV) for at least 24hs were included. Results: 196 patients were admitted to the study, of which 124 (63.3%) received IMV and 72 (37.7%) NIV only. During their stay in PICU 143 (73%) subjects received MT and of these, 89 (62%) started MT within the first 3 days of hospitalization. In the MT group 93 (65%) required IMV and 50 (35%) NIV. All patients who were tracheostomized in PICU received MT. Conclusion: Early mobilization in pediatric critically ill patients was feasible and early in more than 70% of the population studied. Neither age, nor weight, nor ventilatory support were barriers or limiting factors for its implementation.

Hemodynamic impact of early mobilization in critical patients receiving vasoactive drugs: A prospective cohort study.

Vasoactive drugs are one of the most common patient-related barriers to early mobilization. Little is known about the hemodynamic effects of early mobilization on patients receiving vasoactive drugs. This study aims to observe and describe the impact of mobilization on the vital signs of critical patients receiving vasoactive drugs as well as the occurrence of adverse events. This is a cohort study performed in an Intensive Care Unit with patients receiving vasoactive drugs. All patients, either mobilized or non-mobilized, had their clinical data such as vital signs [heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation], type and dosage of the vasoactive drug, and respiratory support collected at rest. For mobilized patients, the vital signs were also collected after mobilization, and so was the highest level of mobility achieved and the occurrence of adverse events. The criteria involved in the decision of mobilizing the patients were registered. 53 patients were included in this study and 222 physiotherapy sessions were monitored. In most of the sessions (n = 150, 67.6%), patients were mobilized despite the use of vasoactive drugs. There was a statistically significant increase in heart rate and respiratory rate after mobilization when compared to rest (p<0.05). Only two (1.3%) out of 150 mobilizations presented an adverse event. Most of the time, non-mobilizations were justified by the existence of a clinical contraindication (n = 61, 84.7%). The alterations observed in the vital signs of mobilized patients may have reflected physiological adjustments of patients' cardiovascular and respiratory systems to the increase in physical demand imposed by the early mobilization. The adverse events were rare, not serious, and reversed through actions such as a minimal increase of the vasoactive drug dosage.

1121 USE OF IMPELLA 5.0 AS BRIDGE TO LVAD IN CARDIOGENIC SHOCK: REPORT OF TWO CASES

Abstract Background Left ventricle assist devices (LVAD) are an option in end stage heart failure (HF) as bridge to or alterative to heart transplantation. Adequate compensation of patient is key to obtain a good outcome. We report two cases of Impella 5.0 bridge to LVAD in patients with cardiogenic shock (CS) in which intra-aortic balloon pump (IABP) failed to obtain hemodynamic stability. Case series A) A 60 years old man developed CS after anterior myocardial infarction treated with primary PCI of left main coronary artery. At presentation patient was hypotensive with signs of hypoperfusion and pulmonary congestion: systemic blood pressure (SBP) 80/60 mmHg despite inotropic drugs, blood lactates 4 mmol/l, urine output of last 6 hours 0,4 ml/kg/h (INTERMACS 2). Echocardiography showed severe left ventricle disfunction with LVEF 15%, severe mitral regurgitation (MR) and sPAP 45 mmHg. Therefore, IABP was implanted. Right heart catheterization (RHC) showed pulmonary hypertension and high filling pressure with reduced cardiac output and increased pulmonary vascular resistance (mPAP 39 mmHg, CPWP 28 mmHg, CO 3 l/min, PVR 3.7 uW, PAPi 2.8); X-ray chest showed persistence of pulmonary congestion. After 9 days on IABP, patient underwent Impella 5.0 implant through right axillary artery as bridge to durable LVAD. Pulmonary artery catheter (PAC) monitoring showed reduction of pulmonary hypertension with mPAP 35 mmHg and CPWP 17 mmHg and chest X-ray documented improvement of lung congestion. Bedside rehabilitation was started. Two weeks later patient underwent LVAD HM3 implantation as destination therapy. The patient was discharge home on post-operative day 55. B) After subacute myocardial infarction with three-vessels disease, a 53 y.o. man developed severe congestive HF with severe left ventricular disfunction and was referred to our institution for evaluation. RHC showed pulmonary hypertension with pre-capillary component not reversible after enoximone test, contraindicating heart transplantation. Therefore, patient was candidate to receive LVAD as bridge strategy. Echocardiography at admission showed dilated and hypokinetic left ventricle (EDV 200 ml, LVEF 17% severe MR, sPAP 60 mmHg) and dilated and hypokinetic RV. During hospitalization the patient experienced CS with SBP 62/45 mmHg, 6-hours urine output of 1,4 ml/kg/h and blood lactates 8.3 mmol/l (INTERMACS 1) so femoral IABP was implanted. RHC was repeated both without IABP support (mPAP 37 mmHg, PCWP 28 mmHg, CO 1.4 l/min, CI 0.9 l/min/m2) and with IABP support (mPAP 32 mmHg, PCWP 18 mmHg, CO 2.15 l/min, CI 1.4 l/min/m2). During the following stay he developed S. Aureus sepsis requiring prolonged antibiotic therapy. Expecting a long time before LVAD, axillary Impella 5.0 was implanted in order to unload the LV and allow early patient mobilization. Subsequent PAC monitoring showed improvement of pulmonary hypertension and cardiac index (mPAP 24 mmHg, PCWP 9 mmHg, CO 5.1 l/min with Impella flow 4.2 l/min, CI 3.2 l/min/m2). After 11 days, patient received LVAD HVAD with uneventful course and was discharged on post-operative day 22. Conclusions Impella 5.0 is a surgically implanted intravascular microaxial blood pump that delivers up to 5 l/min of blood from LV to aorta, leading to improved perfusion and more efficient LV unloading. In patients with CS this can help to obtain better decongestion, RV recovery, and favorable preconditioning before LVAD implant. Moreover, axillary access allows better patient mobilization preventing cachexia after long time hospitalization.

Early physiotherapy and chest wall oscillation in patients with COVID-19 disease at the intensive care unit: a pilot clinical trial

Over the past few years, the early mobilization and rehabilitation of patients in the intensive care unit (ICU) has drawn a lot of interest from the clinical and scientific communities. An interdisciplinary team treating patients suffering from serious conditions should include physiotherapy. Additionally, physiotherapy is utilized to treat and prevent the side effects of extended immobility or sleep, as well as to improve respiratory function. The purpose is to improve residual functionality; to avoid new and repeated hospitalizations; to improve health and quality of life. Exercises for the entire body (including early in-bed cycling), specialized breathing exercises, chest mobilization, relief help, drainage postures, vibration, verticalization, and passive movements are all crucial components of COVID-19 physiotherapy. Our goal was to evaluate the changes of functional condition of patients with COVID-19 in the acute stage using different physiotherapy methods: complex measures against mono therapy. In the research, 28 subjects (15 men and 13 women) were involved. A total of 84 physiotherapy procedures were performed. In the first group, breathing exercises and chest wall oscillation were applied, in the second group – only chest wall oscillation. Respiratory physiotherapy (breathing exercises) plays an important role in reducing and preventing respiratory complications in COVID-19 patients treated at ICU. Early mobilization and chest wall oscillation are beneficial in COVID-19 patients. We note that we are the first to conduct an evidence-based study of physiotherapy in intensive care with COVID-19 patients. We hope that our pilot clinical trial gives opportunity to future researches.

A checklist-based survey for early mobilization of stroke unit patients in an Italian region.

Although early mobilization (EM) is recommended by most guidelines in acute stroke patients, there is a paucity of tools to perform a standardized patient risk assessment prior to EM in stroke units (SUs). This survey aimed at assessing (1) the usefulness of an ad hoc checklist for a standardized approach to EM in SUs and (2) the relationship between EM achieved by this checklist and SU characteristics. This survey was carried out in 10 SUs in Piedmont, Italy. The EM checklist was based on 15 "items", including quantitative/qualitative, clinical and management features. A total of 250 completed checklists were assessed. EM, defined as out-of-bed activity within 72h of admission, was reached by 174 patients (69.6%), according to the checklist. There was a statistically significant association between the admission NIHSS score and EM. Hypotension at mobilization was observed in 29/250 patients (11.6%) and was significantly associated with EM. A total of 6 falls (2.4%) were reported. Nurses were most frequently involved in EM, either alone (40.8%) or with another professional. A large percentage of acute stroke patients managed to achieve a safe EM in the SUs that adopted the novel checklist. These results suggest that this checklist may well be a user-friendly, reliable tool to assist SU professionals in deciding whether to mobilize or not, by means of a standardized approach.

Hubungan antara Efikasi Diri dengan Mobilisasi Dini pada Pasien Paska Bedah Mayor

Introduction: Self-efficacy affects the ability to perform early mobilization in patients after digestive surgery. The characteristics of pain are different in digestive and major surgical pain. Pain can effect self-efficacy and early mobilization. The purpose of this study is to analyze the relationship between self-efficacy and early mobilization of major post-surgical patients.Methods: The study used a correlation descriptive design with a cross sectional approach with a total sample of 62 post operation patients aged 21-65 years who were compos mentis. The research instrument for self-efficacy used The General Self-Efficacy Scale (GSE), while early mobilization used Cumulated Ambulation Afternoon (CAS). Data were analyzed used Spearman rho.Results: The results showed that the mean self-efficacy score was 36,56 and the average value of early mobilization was 2.02. The results of correlation test obtained p value=0.172 with r=0.181.Conclusion: The conclusion of this study is that there was no significant relationship between self-efficacy with early mobilization. The suggestion in the study is to examine other factors that can affect early postoperative mosbilization. Keywords: Early Mobilization, Major Post-Surgical, Self-Efficacy.

Hubungan antara Efikasi Diri dengan Mobilisasi Dini pada Pasien Paska Bedah Mayor

Introduction: Self-efficacy affects the ability to perform early mobilization in patients after digestive surgery. The characteristics of pain are different in digestive and major surgical pain. Pain can effect self-efficacy and early mobilization. The purpose of this study is to analyze the relationship between self-efficacy and early mobilization of major post-surgical patients.Methods: The study used a correlation descriptive design with a cross sectional approach with a total sample of 62 post operation patients aged 21-65 years who were compos mentis. The research instrument for self-efficacy used The General Self-Efficacy Scale (GSE), while early mobilization used Cumulated Ambulation Afternoon (CAS). Data were analyzed used Spearman rho.Results: The results showed that the mean self-efficacy score was 36,56 and the average value of early mobilization was 2.02. The results of correlation test obtained p value=0.172 with r=0.181.Conclusion: The conclusion of this study is that there was no significant relationship between self-efficacy with early mobilization. The suggestion in the study is to examine other factors that can affect early postoperative mosbilization. Keywords: Early Mobilization, Major Post-Surgical, Self-Efficacy.

What's New in Musculoskeletal Tumor Surgery.

What's New in Musculoskeletal Tumor Surgery.

Robot-assisted early mobilization of intensive care patients: a feasibility study protocol

BackgroundEarly mobilization positively influences the outcome of critically ill patients, yet in clinical practice, the implementation is sometimes challenging. In this study, an adaptive robotic assistance system will be used for early mobilization in intensive care units. The study aims to evaluate the experience of the mobilizing professionals and the general feasibility of implementing robotic assistance for mobilization in intensive care as well as the effects on patient outcomes as a secondary outcome.MethodsThe study is single-centric, prospective, and interventional and follows a longitudinal study design. To evaluate the feasibility of robotic-assisted early mobilization, the number of patients included, the number of performed VEM (very early mobilization) sessions, and the number and type of adverse events will be collected. The behavior and experience of mobilizing professionals will be evaluated using standardized observations (n > 90) and episodic interviews (n > 36) before implementation, shortly after, and in routine. Patient outcomes such as duration of mechanical ventilation, loss of muscle mass, and physical activity will be measured and compared with a historical patient population. Approximately 30 patients will be included.DiscussionThe study will provide information about patient outcomes, feasibility, and the experience of mobilizing professionals. It will show whether robotic systems can increase the early mobilization frequency of critically ill patients. Within ICU structures, early mobilization as therapy could become more of a focus. Effects on the mobilizing professionals such as increased motivation, physical relief, or stress will be evaluated. In addition, this study will focus on whether current structures allow following the recommendation of mobilizing patients twice a day for at least 20 min.Trial registrationClinicalTrials.gov, NCT05071248. Date: 2021/10/21

Impact of Physiotherapy on Functional Status and Length of Stay of Patients Admitted to Intensive Care Unit

Background: Early mobilization of patients with critical illness reduces the consequences of extended periods of bed rest and improves self-care functions and quality of life. Early mobilization for mechanically ventilated patients in any ICU prevents patients from a spiral of progressive complications, leading to either nursing home placement or persistent critical illness. Early mobilization of ICU patients has been associated with improved muscle strength and functional independence, a shorter duration of delirium, mechanical ventilation, and ICU length of stay. Objective: This study was undertaken to assess the impact of physiotherapy management and early mobilization on Functional Status and Length of Stay in patients admitted to the Intensive Care Unit. Methods: An observational study was conducted at a tertiary care university teaching hospital in Mysore, South India, among patients admitted to medical and surgical intensive care units. The patients were assessed, and the patient’s baseline characteristics were recorded. The study subjects were divided into two groups, the intervention and the control groups. There were 71 patients in the intervention group and 67 patients control group. Subjects in the intervention group underwent physiotherapy management and early mobilization. Subjects in the control group did not undergo physiotherapy management and early mobilization. Physiotherapy intervention was given 2-3 times/day, and the outcome measures were the length of stay in ICU and assessment of physical morbidity using the Chelsea Critical Care Physical Assessment Tool (CPAx). Results: The results showed that subjects in the intervention group were weaned from the ventilator support (3.86±3.4 and 5.59±4.3, p = 0.005) and oxygen support (5.23±0.99 and 7.48±2.0, p = 0.000) much earlier than the subjects in the control group. The length of ICU stay was significantly less in the intervention group than in the control group (7.71±3.70 days and 11.64±4.8 days with a p-value, p = 0.000). respectively Conclusion: This study demonstrated that implementation of physiotherapy intervention and early mobilization in critically ill patients undergoing treatment in intensive care unit resulted in early weaning from ventilator support and supplemental oxygen therapy, with improvement in functional status leading to reduced length of ICU stays compared to the patients who were not given physiotherapy intervention and early mobilization.

Perioperative outcome of minimally invasive stabilisation of bilateral fragility fractures of the sacrum: a comparative study of bisegmental transsacral stabilisation versus spinopelvic fixation

PurposePelvic fragility fractures have steadily risen over the past decades. The primary treatment goal is the fastest possible mobilisation. If conservative therapy fails, surgical fixation is a promising approach. This study compares the outcome of bisegmental transsacral stabilisation (BTS) and spinopelvic fixation (SP) as minimally invasive techniques for bilateral fragility fractures of the sacrum (BFFS).MethodsWe performed a prospective, non-randomised, case-controlled study. Patients were included if they remained bedridden due to pain despite conservative treatment. Group assignment depended on sacral anatomy and fracture type. The outcome was estimated by blood loss calculation, cut-seam time, fluoroscopy time, complications, duration of stay at the intensive/intermediate care unit (ICU/IMC), and total inpatient stay. The mobility level at discharge was recorded.ResultsSeventy-three patients were included (SP: 49, BTS: 24). There was no difference in blood loss (BTS: 461 ± 628 mL, SP: 509 ± 354 mL). BTS showed a significantly lower cut-seam time (72 ± 23 min) than SP (94 ± 27 min). Fluoroscopy time did not differ (BTS: 111 ± 61 s vs. 103 ± 45 s). Thirteen percent of BTS and 16% of SP patients required ICU/IMC stay (BTS: 0.6 ± 1.8 days, SP: 0.5 ± 1.5 days) during inpatient stay (BTS: 9 ± 4 days, SP: 8 ± 3 days). Fourteen patients suffered from urinary tract infections (BTS: 8%; SP: 25%). In-patient mortality was low (BTS: 4.2%, SP: 4.1%). At discharge, the BTS group was almost back to the initial mobility level. In SP patients, mobility was significantly lower than before complaints (p = 0.004).ConclusionBoth methods allow early mobilization of BFFS patients. Blood loss can be kept low. Hence, transfusion requirement is correspondingly low. The IMC/ICU and the total inpatient stay are lower than reported in the literature. Both BTS and SP can be recommended as safe and low-complication methods for use in BFFS patients. BTS is superior to SP with respect to surgery duration and level of mobility at discharge.

Early rehabilitation and mobilisation of neonatal and paediatric extracorporeal membrane oxygenation patients: A UK and Ireland consensus document.

Despite increasing early rehabilitation and mobilisation (ERM) in paediatric intensive care, current evidence for ERM of neonatal and paediatric patients receiving extracorporeal membrane oxygenation (ECMO) is limited. The proposed benefits of ERM in neonatal and paediatric ECMO patients are multifaceted, including reduced immobility related issues and maintenance of functional ability. However, ECMO presents additional safety and logistical challenges, and currently there are no published neonatal or paediatric guidelines. A consensus document was developed to provide guidance for ERM with neonatal and paediatric ECMO patients. The document was developed by specialist physiotherapists from nine ECMO centres within the UK and Ireland, together with the UK Paediatric Critical Care Society ECMO group and members of the multidisciplinary team. The document covers key considerations and practicalities for completing ERM in this population including, acuity level measurement, activity level guidance, safety and risk assessment, and goal setting. Risk assessment and safety checklist bedside tools are also included and designed to be adapted as required to meet specific unit policies and protocols.

JUMPSTART-TAVR PILOT: EVALUATION OF AN EARLY MOBILIZATION VIRTUAL EXERCISE MODULE POST TAVR

Trans-catheter aortic valve replacement (TAVR) has evolved rapidly and most patients are discharged home the next day. To our knowledge, there are no existing protocols for a TAVR specific exercise mobilization program. JUMPSTART-TAVR is designed as a virtual, self-directed and tailored exercise program that includes a variety of low intensity stretches and exercise modules to improve the early mobilization of TAVR patients post discharge. The objective of this pilot was to assess the acceptability and feasibility of the index virtual exercise module.

Neuromuscular blocking agents and opioids are major risk factors for developing pressure injuries in patients in the intensive care unit.

Patients in the intensive care unit (ICU) are at high risk for developing pressure injuries, which can cause severe complications and even increase the mortality risk. Therefore, prevention of pressure injuries is most important. In this study, we investigated the risk factors of pressure injury development in patients admitted to the ICU. We retrospectively analyzed patients ages &gt; 18 years admitted to the medical ICU in a tertiary hospital between January and December 2019. We collected patient baseline characteristics, medications received, mechanical ventilation or hemodialysis use, laboratory findings, and date of pressure injury onset and characteristics. We analyzed 666 patients who did not have pressure injuries at ICU admission. Pressure injuries developed in 102 patients (15%). The risk of pressure injury development increased as the administration days for neuromuscular blocking agents (NMBAs; odds ratio [OR], 1.138; p = 0.019) and opioids (OR, 1.084; p = 0.028) increased, and if the patient had problem with friction and shear (OR, 2.203; p = 0.011). The prolonged use of NMBAs and opioids can increase the risk of pressure injury development. Because these medications are associated with immobilization, using both should be minimized and patient early mobilization should be promoted. Among the Braden subscales, "friction and shear" was associated with the development of pressure injuries in ICU patients.

Expert consensus on the diagnosis and treatment of severe and critical coronavirus disease 2019.

Expert consensus on the diagnosis and treatment of severe and critical coronavirus disease 2019.

Management of intertrochanteric femur fracture by proximal femoral nail and its functional outcome: A prospective study

Background: Intertrochanteric fractures are commonly encountered in orthopedics practice. Achieving early mobilization in patients with intertrochanteric fractures is the cornerstone of management. Proximal femoral nailing (PFN) is gaining popularity because of better tolerance of this procedure as well as minimal complication rates. We conducted this study to find out the functional outcome of patients with intertrochanteric fractures treated by PFN. Aims and Objectives: The objectives are as follows: (1) To find out the functional outcome of patients with intertrochanteric fractures treated by PFN. (2) To find out complications in patients treated by PFN. Materials and Methods: 60 patients with intertrochanteric fracture were included in this prospective study on the basis of a predefined inclusion and exclusion criteria. Under spinal anesthesia closed reduction and internal fixation by PFN were done. Open reduction was done in cases where closed reduction was not possible. Functional outcome as assessed by Harris hip score. Statistical analysis was done using SSPS 21.0 Software and P&lt;0.05 was taken as statistically significant. Results: Out of 60 studied cases there were 37 (61.67%) males and 23 (38.33%) females with a M: F ratio of 1:0.62. The most common type of fracture was AO A3.2 (simple transverse fracture) which was seen in 28 (46.67%) patients followed by AO A3.1 (Simple Oblique fracture) and AO A3.3 (wedge fracture or multi-fragmentary fracture). Functional outcome was excellent to good in 41 (68.33%) patients whereas fair and poor outcome was seen in 12 (20%) and 5 (8.33%) patients, respectively. Very poor outcome was seen in 2 (3.33%) patients. Conclusion: PFN is an excellent technique for management of intertrochanteric fractures. It is associated with excellent outcome in majority of the cases and is associated with minimal complications.

Comparison of enhanced recovery protocol with conventional care in patients undergoing urogynecological surgery.

The impact of enhanced recovery after surgery (ERAS) protocol on postoperative outcomes after urogynecological surgery is yet to be a matter of investigation. This study sought to evaluate this issue by comparing the patients who had conventional or ERAS--guided perioperative care for several clinical end-points including ambulation, length of hospital stay (LOS), readmissions, and postoperative complications. A total of 121 patients undergoing pelvic organ prolapse surgery were allocated to two study arms, ERAS protocol (Group E) or conventional care (Group C). Variables reflecting the restoration of appetite and bowel movements, bleeding events, other complications, LOS and readmissions were compared between the groups. The patients in Group C significantly received a more intensive intravenous fluid treatment compared to Group E (2,760 ± 656 vs. 1,045 ± 218 mL, P < 0.001). Time required for first flatus, first defecation, eating solid food, and ambulation (P < 0.001) were also longer in the former group of patients. Moreover, LOS was significantly reduced when the ERAS protocol was applied (2.5 ± 1.1 vs. 2.0 ± 0.6 days, P < 0.001). On the other hand, the two groups were similar with respect to the frequency of the postoperative complications, including surgical site infections, cardiovascular complications, non-specific abdominal pain, sub-ileus, blood loss and readmission rate. In our sample population, ERAS protocol led to early initiation of oral intake, early recovery of bowel function, early mobilization, and early discharge of patients without compromise in safety concerns after urogynecological surgery.

Effect of early mobilization in patients with stroke and severe disturbance of consciousness: Retrospective study

ObjectivesThis study aimed to investigate the effectiveness and safety of early mobilization with a physiatrist and registered therapist Operating rehabilitation (PROr) for patients with stroke and severe disturbance of consciousness (DoC). Materials and methodsWe retrospectively screened records from patients with stroke admitted to our hospital from January 2015 to June 2021. Eligible patients with severe DoC were classified into two groups: patients who received standard rehabilitation (control group) and patients who received PROr (PROr group). We studied longitudinal change in the level of consciousness using the Japan Coma Scale (JCS) during hospital stay and compared in-hospital mortality, the incidence of respiratory complication, and modified Rankin Scale of discharge between the two groups. ResultsAmong the 2191 patients screened for inclusion, 16 patients were included in the PROr group, and 12 patients were included in the control group. Early mobilization was more promoted in the PROr group compared to the control group, but there were no significant differences in in-hospital mortality, the incidence of respiratory complication, or modified Rankin Scale at discharge between the two groups. In patients who survived during their hospital stay, JCS scores 2 weeks after the onset of stroke and JCS scores at discharge significantly improved from the start of rehabilitation in the PROr group, but not in the control group. ConclusionsEarly mobilization provided with the PROr program appears to be a safe treatment and may contribute to the improvement of consciousness level for patients with acute stroke and severe DoC.

A Novel Mobilization Criteria Checklist 12 to 24 Hours After Intravenous Thrombolysis in Acute Ischemic Stroke

Purpose: This study describes the development and utilization of a novel mobilization criteria checklist that can guide clinical decision making to safely initiate very early mobilization for patients with acute ischemic stroke within 12 to 24 hours after intravenous (IV) thrombolysis. Methods: The evidence was examined, and risk factors for hemorrhagic transformation and considerations for initiating or terminating mobility within the first 12 to 24 hours were identified. The information was formatted into a mobilization criteria checklist for use in a case study 12 to 24 hours after tissue plasminogen activator (tPA), an IV thrombolytic, was given for acute ischemic stroke at a certified comprehensive stroke center. Outcomes: The tool was an additive to clinical practice and provided a clinical guide to optimize patient safety for an established institutional practice. Discussion: A mobilization criteria checklist is a helpful tool to screen for serious risk factors of hemorrhagic transformation in the first 24 hours after IV thrombolysis for acute ischemic stroke. With further development, the foundational concepts may guide future research to establish clinical practice guidelines and a standard of care to optimize the selection of patients most appropriate for mobility within 12 to 24 hours.