Longer Time Before Acute Rehabilitation Therapy Worsens Disability After Intracerebral Hemorrhage.
Carmen E Capo-Lugo, Robert L Askew, Kathryn Muldoon and 4 others
PMID 31874157WHAT IT FOUND
Every extra day between hospital admission and the first rehab consult raised the odds of poor disability outcomes at 30 and 90 days.
Delays were longest for patients in the ICU, those with low consciousness, or those who could walk before the stroke.
Key findings
01Each additional day between admission and initiation of acute rehabilitation therapy was associated with increased odds of poor outcome (mRS >= 4) at 30 days and 90 days.
02Longer ICU stays, current alcohol abuse, lower consciousness scores, and better pre-morbid mobility were independently associated with longer delays to starting rehab.
03Initiating acute rehabilitation after 6 days was more likely to lead to poor outcome at 30 and 90 days.
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
The study was conducted at a single acute care center, so practices may not apply elsewhere. Rehabilitation services provided after the initial hospital stay were not accounted for. The modified Rankin Scale used for outcomes focuses mainly on mobility and does not capture cognitive or executive function impairments. Some participants were lost to follow-up for disability scores at 30 and 90 days. No patient in the study received rehabilitation within 24 hours of admission, so the results do not address ultra-early mobilization.
Declared interests
The research was supported by the National Institutes of Health, the U.S. Government, and non-U.S. government sources. No commercial sponsor or author conflicts of interest are declared in the text.
The easy way to misread this
Do not interpret this as evidence that mobilizing within 24 hours is beneficial. No patient in this study received therapy within 24 hours, and the authors note that ultra-early rehab can be harmful in hemorrhagic stroke. The finding applies to reducing delays during the acute hospital stay, not to immediate bedside mobilization.