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Open Access Special Issue

Is early mobilization associated with functional improvement in acute middle cerebral artery ischemic stroke treated with recombinant tissue plasminogen activator? A proof of concept and retrospective single-center study

  • Hsiao-Ching Yen1
  • Jiann-Shing Jeng2
  • Wen-Ying Chuang1
  • Wen-Shiang Chen3

1Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan

2Stroke Center & Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan

3Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan

DOI: 10.22514/sv.2021.016 Vol.17,Issue 2,March 2021 pp.174-180

Published: 08 March 2021

(This article belongs to the Special Issue Advances in the Management of Acute Ischemic Stroke)

*Corresponding Author(s): Hsiao-Ching Yen E-mail: jassicayen@yahoo.com.tw

Abstract

Background: The benefit of commencing early mobilization for patients after ischemic stroke (IS) is well established. However, the timing and benefits of early mobilization in recombinant tissue plasminogen activator (rtPA)-treated patients remain mostly undefined.

Methods: In this retrospective observational cohort study, we analyzed rtPA-treated patients after a first-episode middle cerebral artery (MCA)-IS, that were admitted in a Stroke Center, using electronic medical records during the period of January 1, 2015 through December 31, 2017. These patients who received a standard early rehabilitation during the stay in the Stroke Center served as the control group. We examined the association between early mobilization via early rehabilitation within 24-72 hours and activities of daily living and postural control improvements, as indicated by the Barthel Index (BI) effectiveness and the Postural Assessment Scale for Stroke (PASS) effectiveness, respectively.

Results: Total 60 patients with a first MCA-IS treated after rtPA were analyzed. Multiple linear regression analysis indicated that BI and PASS effectiveness were positively correlated with not only age and the stroke severity at 24 hours after rtPA treatment but commencing early mobilization within 24-72 hours after stroke in patients with a first MCA-IS treated after rtPA.

Conclusions: This study concludes that early mobilization may be associated with an acceleration of functional improvement in patients with a first MCA-IS treated with rtPA within four weeks after the onset.


Keywords

Acute stroke; Early mobilization; Thrombolytic therapy; Functional outcome; rtPA


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Hsiao-Ching Yen,Jiann-Shing Jeng,Wen-Ying Chuang,Wen-Shiang Chen. Is early mobilization associated with functional improvement in acute middle cerebral artery ischemic stroke treated with recombinant tissue plasminogen activator? A proof of concept and retrospective single-center study. Signa Vitae. 2021. 17(2);174-180.

References

[1] Yasaka M, O’Keefe GJ, Chambers BR, Davis SM, Infeld B, O’Malley H, et al. Streptokinase in acute stroke: effect on reperfusion and recanalization. Australian Streptokinase Trial Study Group. Neurology. 1998; 50: 626-632.

[2] Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJB, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013; 44: 870-947.

[3] Ha J, Churilov L, Linden T, Bernhardt J. Bed rest or mobilization after rt-PA? A case-crossover study of factors influencing clinical decision making in stroke services. International Journal of Stroke. 2013; 8: 172-179.

[4] Diserens K, Moreira T, Hirt L, Faouzi M, Grujic J, Bieler G, et al. Early mobilization out of bed after ischaemic stroke reduces severe complications but not cerebral blood flow: a randomized controlled pilot trial. Clinical Rehabilitation. 2012; 26: 451-459.

[5] Cumming TB, Thrift AG, Collier JM, Churilov L, Dewey HM, Donnan GA, et al. Very early mobilization after stroke fast-tracks return to walking: further results from the phase II AVERT randomized controlled trial. Stroke. 2011; 42: 153-158.

[6] Bernhardt J, Dewey H, Collier J, Thrift A, Lindley R, Moodie M, et al. A very early rehabilitation trial (AVERT). International Journal of Stroke. 2008; 1: 169-171.

[7] Horn SD, DeJong G, Smout RJ, Gassaway J, James R, Conroy B. Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better? Archives of Physical Medicine and Rehabilitation. 2005; 86: S101-S114.

[8] Langhorne P, Stott D, Knight A, Bernhardt J, Barer D, Watkins C. Very early rehabilitation or intensive telemetry after stroke: a pilot randomised trial. Cerebrovascular Diseases. 2010; 29: 352-360.

[9] Indredavik B, Bakke F, Slordahl SA, Rokseth R, Hâheim LL. Treatment in a combined acute and rehabilitation stroke unit: which aspects are most important? Stroke. 1999; 30: 917-923.

[10] Zhang P, Zhang Q, Pu H, Wu Y, Bai Y, Vosler PS, et al. Very early-initiated physical rehabilitation protects against ischemic brain injury. Frontiers in Bioscience. 2012; 4: 2476-2489.

[11] Zhang A, Bai Y, Hu Y, Zhang F, Wu Y, Wang Y, et al. The effects of exercise intensity on p-NR2B expression in cerebral ischemic rats. The Canadian Journal of Neurological Sciences. 2012; 39: 613-618.

[12] Zhang Y, Zhang P, Shen X, Tian S, Wu Y, Zhu Y, et al. Early exercise protects the blood-brain barrier from ischemic brain injury via the regulation of MMP-9 and occludin in rats. International Journal of Molecular Sciences. 2013; 14: 11096-11112.

[13] Lee M, Kim H, Kim S, Lee T, Lim B, Chang H, et al. Treadmill exercise suppresses ischemia-induced increment in apoptosis and cell proliferation in hippocampal dentate gyrus of gerbils. Life Sciences. 2003; 73: 2455-2465.

[14] Zhang L, Hu X, Luo J, Li L, Chen X, Huang R, et al. Physical exercise improves functional recovery through mitigation of autophagy, attenuation of apoptosis and enhancement of neurogenesis after MCAO in rats. BMC Neuroscience. 2013; 14: 46.

[15] Kim M, Bang M, Han T, Ko Y, Yoon B, Kim J, et al. Exercise increased BDNF and trkB in the contralateral hemisphere of the ischemic rat brain. Brain Research. 2005; 1052: 16-21.

[16] Luo CX, Jiang J, Zhou QG, Zhu XJ, Wang W, Zhang ZJ, et al. Voluntary exercise-induced neurogenesis in the postischemic dentate gyrus is associated with spatial memory recovery from stroke. Journal of Neuroscience Research. 2007; 85: 1637-1646.

[17] Bernhardt J, Chitravas N, Meslo IL, Thrift AG, Indredavik B. Not all stroke units are the same: a comparison of physical activity patterns in Melbourne, Australia, and Trondheim, Norway. Stroke. 2008; 39: 2059-2065.

[18] Kwakkel G, Wagenaar RC, Koelman TW, Lankhorst GJ, Koetsier JC. Effects of intensity of rehabilitation after stroke. A research synthesis. Stroke. 1997; 28: 1550-1556.

[19] Momosaki R, Yasunaga H, Kakuda W, Matsui H, Fushimi K, Abo M. Very early versus delayed rehabilitation for acute ischemic stroke patients with intravenous recombinant tissue plasminogen activator: a nationwide retrospective cohort study. Cerebrovascular Diseases. 2016; 42: 41-48.

[20] Muhl L, Kulin J, Dagonnier M, Churilov L, Dewey H, Lindén T, et al. Mobilization after thrombolysis (rtPA) within 24 hours of acute stroke: what factors influence inclusion of patients in a very Early Rehabilitation Trial (AVERT)? BMC Neurology. 2014; 14: 163.

[21] Ringleb PA, Bousser M, Ford G, Bath P, Brainin M, Caso V, et al. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovascular Diseases. 2008; 25: 457-507.

[22] Matsuda S, Ishikawa KB, Kuwabara K, Fujimori K, Fushimi K, Hashimoto H. Development and use of the Japanese case-mix system. Eurohealth. 2008; 14: 27-30.

[23] Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016; 47: e98-e169.

[24] Benaim C, Pérennou DA, Villy J, Rousseaux M, Pelissier JY. Validation of a Standardized Assessment of Postural Control in Stroke Patients. Stroke. 1999; 30: 1862-1868.

[25] Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Maryland State Medical Journal. 1965; 14: 61-65.

[26] Al-Khaled M, Matthis C, Eggers J. Predictors of in-hospital mortality and the risk of symptomatic intracerebral hemorrhage after thrombolytic therapy with recombinant tissue plasminogen activator in acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases. 2014; 23: 7-11.

[27] Wahlgren N, Ahmed N, Eriksson N, Aichner F, Bluhmki E, Dávalos A, et al. Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials: Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy (SITS-most). Stroke. 2008; 39: 3316-3322.

[28] Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical Care. 2005; 43: 1130-1139.

[29] Koh GC, Chen CH, Petrella R, Thind A. Rehabilitation impact indices and their independent predictors: a systematic review. BMJ Open. 2013; 3: e003483.

[30] Bernhardt J, Churilov L, Ellery F, Collier J, Chamberlain J, Langhorne P, et al. Prespecified dose-response analysis for a very early rehabilitation trial (AVERT). Neurology. 2016; 86: 2138-2145.

[31] Arnold SM, Dinkins M, Mooney LH, Freeman WD, Rawal B, Heckman MG, et al. Very early mobilization in stroke patients treated with intravenous recombinant tissue plasminogen activator. Journal of Stroke and Cerebrovascular Diseases. 2015; 24: 1168-1173.

[32] Murphy TH, Corbett D. Plasticity during stroke recovery: from synapse to behaviour. Nature Reviews Neuroscience. 2009; 10: 861-872.

[33] Nudo RJ, Friel KM. Cortical plasticity after stroke: implications for rehabilitation. Revue Neurologique. 1999; 155: 713-717.

[34] Krakauer JW, Carmichael ST, Corbett D, Wittenberg GF. Getting neurorehabilitation right: what can be learned from animal models?Neurorehabilitation and Neural Repair. 2012; 26: 923-931.

[35] Riachy M, Sfeir F, Sleilaty G, Hage-Chahine S, Dabar G, Bazerbachi T, et al. Prediction of the survival and functional ability of severe stroke patients after ICU therapeutic intervention. BMC Neurology. 2008; 8: 24.

[36] Ducci RD, Lange MC, Zétola VDHF. Predictors of in-hospital mortality and dependence at discharge in patients with MCA stroke with intravenous thrombolysis. Internal and Emergency Medicine. 2017; 12: 453- 460.

[37] Kablau M, Alonso A, Hennerici MG, Fatar M. Treatment with tPA predicts better outcome even if MCA occlusion persists. International Journal of Stroke. 2013; 8: 496-502.

[38] Yeo LL, Paliwal P, Teoh HL, Seet RC, Chan BP, Wakerley B, et al. Early and continuous neurologic improvements after intravenous thrombolysis are strong predictors of favorable long-term outcomes in acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases. 2013; 22: e590-e596.

[39] Kharitonova T, Mikulik R, Roine RO, Soinne L, Ahmed N, Wahlgren N. Association of early National Institutes of Health Stroke Scale improvement with vessel recanalization and functional outcome after intravenous thrombolysis in ischemic stroke. Stroke. 2011; 42: 1638-1643.

[40] Spiotta AM, Vargas J, Hawk H, Turner R, Chaudry MI, Battenhouse H, et al. Impact of the ASPECT scores and distribution on outcome among patients undergoing thrombectomy for acute ischemic stroke. Journal of Neurointerventional Surgery. 2015; 7: 551-558.

[41] Campbell BCV, Donnan GA, Lees KR, Hacke W, Khatri P, Hill MD, et al. Endovascular stent thrombectomy: the new standard of care for large vessel ischaemic stroke. The Lancet Neurology. 2015; 14: 846-854.


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