Early Mobilization, Primary Intracerebral Hemorrhage
Conditions
Keywords
Intracerebral hemorrhage, Early mobilization, Stroke unit, Clinical pathway
Brief summary
Primary intracerebral hemorrhage (ICH) is a severe and life-threatening condition with a high mortality rate, reaching up to 50% within the first month. Survivors are often at risk of long-term disability due to the extensive brain damage caused by the hemorrhage. Unlike ischemic stroke patients, ICH patients are typically younger, face longer hospital stays, and are more likely to experience acute complications. Modern treatment approaches have shifted from focusing solely on reducing mortality to minimizing disability and enhancing functional outcomes through early rehabilitation. However, the optimal timing and intensity of early mobilization remain unclear, especially for patients with severe ICH, where medical stability is a major concern. Delays in initiating rehabilitation may limit neuroplasticity and hinder recovery, prompting the need for a structured, multidisciplinary approach to early mobilization in ICH patients. Objective : This quality improvement (QI) initiative aimed to enhance early mobilization in ICH patients by implementing a structured clinical pathway in an academic stroke center. The goal was to integrate evidence-based early mobilization pathways to improve patient mobility outcomes while ensuring safety through standardized assessments of cardiovascular, respiratory, and neurological stability.
Interventions
PROCEDUREpost-implementation cohort
Patients recieved a structured early mobilization pathway was introduced. The pathway included standardized assessments for patient stability and phased rehabilitation, progressing from passive to active mobilization.
Sponsors
National Taiwan University Hospital
Study design
Observational model
OTHER
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Clinical diagnosis of primary ICH * ICH score from 0 to 4 * Patients In line with the stroke center's standard criteria for early rehabilitation
Exclusion criteria
* Patients with traumatic brain injury, hemorrhagic transformation of ischemic stroke, or hemorrhage related to underlying malignancy * Patients placed in palliative care or those who died before initial hospital discharge
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Modified ICU mobility scale | through study completion, an average of 12 weeks | The Modified ICU Mobility Scale is used to assess the level of mobility in ICU patients, with scores ranging from 0 to 10. A higher score indicates better mobility, where 0 represents no mobility (lying in bed, passive movements only), and 10 indicates independent ambulation without assistance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| the time to first mobilization | Through study completion, an average of 12 weeks | The time to first mobilization (in hours or days) will be assessed from hospital admission to the first documented mobilization event, measured through study completion, with an average follow-up period of 12 weeks. |
| National Institutes of Health Stroke Scale (NIHSS) score | through study completion, an average of 12 weeks | The National Institutes of Health Stroke Scale (NIHSS) is used to assess stroke severity, with scores ranging from 0 to 42. A higher score indicates a worse neurological impairment, where 0 represents no stroke symptoms, and higher scores reflect increasing severity of stroke-related deficits. |
| Modified Rankin Scale (mRS) | through study completion, an average of 12 weeks | The Modified Rankin Scale (mRS) is used to assess functional outcomes, with scores ranging from 0 to 6. A higher score indicates a worse outcome, where 0 represents no symptoms, and 6 indicates death. |
| Duration of ICU and hospital stays | Through study completion, an average of 12 weeks | The duration of ICU stay (in days) and total hospital stay (in days) will be assessed through study completion, with an average follow-up period of 12 weeks. |
| ability to ambulate upon discharge | through study completion, an average of 12 weeks | — |
Countries
Taiwan
Outcome results
None listed