Early Mobilization in Patients With Aneurysmal Subarachnoid Haemorrhage: A Prospective Observational Study

ABSTRACT Importance Patients with aneurysmal subarachnoid haemorrrhage (aSAH) represent a cohort with limited evidence to guide mobilization practices. Objective The objective was to describe acute mobilization practices, outcomes, and barriers to mobilization in patients following aSAH. Design The design of the study was a single-centre prospective, observational study. Setting This study was conducted in the acute ward and intensive care unit of a tertiary neurosurgical referral centre. Participants Participants were adult (≥18 years) patients post-aSAH with secured aneurysms. Exposure Mobilization practices were delivered during physical therapist sessions up to 14 days post-aneurysm repair. Main Outcomes and measures Severity was classified using the World Federation of Neurological Surgeons (WFNS) scale, dichotomizing into “good” (Grade I to II) and “poor” (Grade III to V) clinical status. Mobilization outcomes were measured using the Mobility Scale for Acute Stroke (MSAS), with independent walking assessed. Results A total of 102 patients participated with 69 (67.6%) classified as “good” grade and 90 (88.2%) of patients mobilized within the first 14 days. Data were collected from 603 planned mobilization sessions, with barriers to mobilization encountered in 193 (32.0%) of these sessions, primarily due to neurological instability (n = 80, 41.5%) and haemodynamic instability (n = 43, 22.3%). Overall, the highest median MSAS score achieved was 32 (IQR = 10 to 36). By 2 weeks, 65.2% of patients with a “good” clinical status walked independently versus 12.9% in the “poor” group. Conclusions While most patients mobilized, physiological instability commonly prevented mobilization activities. Independent walking by 2 weeks was significantly more common in patients with “good” clinical status. These findings underline the importance of careful screening and monitoring during mobilization in the acute period. Relevance This study underscores the need for further research into optimal mobilization strategies for improving outcomes in patients with aSAH.