Effects of mobility dose on discharge disposition in critically ill stroke patients

Abstract

Background: Mobilization in the intensive care unit (ICU) has the potential to improve patient outcomes following acute stroke. The optimal duration and intensity of mobilization for patients with hemorrhagic or ischemic stroke in the ICU remain unclear. Objective: To assess the effect of mobilization dose in the ICU on adverse discharge disposition in patients after stroke. Design: This is an international, prospective, observational cohort study of critically ill stroke patients (November 2017–September 2019). Duration and intensity of mobilization was quantified daily by the mobilization quantification score (MQS). Setting: Patients requiring ICU-level care were enrolled within 48 hours of admission at four separate academic medical centers (two in Europe, two in the United States). Participants: Participants included individuals (>18 years old) admitted to an ICU within 48 hours of ischemic or hemorrhagic stroke onset who were functionally independent at baseline. Interventions: Not applicable. Main Outcome Measure: The primary outcome was adverse discharge disposition. Results: Of the patients screened, 163 were eligible for inclusion in the study. One patient was subsequently excluded due to insufficient data collection (n = 162). The dose of mobilization varied greatly between centers and patients, which could not be explained by patients' comorbidities or disease severity. High dose of mobilization (mean MQS > 7.3) was associated with a lower likelihood of adverse discharge (adjusted odds ratio, [aOR]: 0.14; 95% confidence interval [CI]: 0.06–0.31; p <.01). Conclusion: The increased use of mobilization acutely in the ICU setting may improve patient outcomes.