Early mobilization in patients with aneurysmal subarachnoid haemorrhage may im-prove functional status and reduce cerebral vasospasm rate: a systematic review with meta-analysis.
Adéla Foudhaili, Brice Leclere, Florence Martinache and 3 others
PMID 39421981WHAT IT FOUND
Early mobilization in subarachnoid haemorrhage was linked to better function at discharge and 3 months, and fewer cerebral vasospasms.
Adverse events occurred in 6% of sessions, mostly minor blood pressure changes. Most evidence came from small, non-randomised studies, so treat this as a signal for safety and potential benefit rather than proof.
Key findings
01Pooled analysis showed significant improvement in functional status (mRS) at ICU discharge and 3 months favouring early mobilization.
02Early mobilization was associated with a lower probability of symptomatic and radiographic cerebral vasospasm.
03Adverse events occurred in 6% of mobilization sessions, with haemodynamic changes being the most common.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Only one randomized controlled trial was included, and it had moderate risk of bias and questionable statistical power. The remaining 15 studies were non-randomized (cohort, case-control, before-after), which limits causal inference. There was high heterogeneity in mobilization protocols, timing, and intensity across studies. Most studies included patients with good-grade SAH, so results may not apply to poor-grade patients. The definition of 'early' mobilization varied, with some studies initiating within 24 hours and others within 7 days. Adverse event definitions were inconsistent, making safety comparisons difficult. Cognitive and quality of life outcomes were under-reported.
Declared interests
The research received no specific external funding. One author (Adela Foudhaili) receives an institutional grant from Assistance Publique-Hôpitaux de Paris for her PhD. Three authors were co-authors of one included study, so external reviewers handled data extraction and quality assessment for that paper.
The easy way to misread this
Do not interpret the positive associations as proof that early mobilization causes better outcomes. The evidence is driven largely by low-quality, non-randomized studies with significant heterogeneity in intervention protocols. The single RCT included was negative for some outcomes and had methodological concerns. Treat these findings as hypothesis-generating for safety and feasibility rather than definitive evidence of efficacy.