Early mobilization in patients with aneurysmal subarachnoid hemorrhage: a prospective observational study

Sabrina Hernandez; Claire Tipping; Adam M Deane; Michael Wei; Wendy Bower; Alexios Adamides; Anais Charles-Nelson; Peter Thomas; Jonathan Tomkins; Jane Larkin; Carol L Hodgson

doi:10.1093/ptj/pzag031

Early mobilization in patients with aneurysmal subarachnoid hemorrhage: a prospective observational study

Phys Ther. 2026 Apr 7;106(4):pzag031. doi: 10.1093/ptj/pzag031.

Authors

Sabrina Hernandez^{1

2}, Claire Tipping³, Adam M Deane⁴, Michael Wei⁵, Wendy Bower^{1

6}, Alexios Adamides⁵, Anais Charles-Nelson², Peter Thomas⁷, Jonathan Tomkins¹, Jane Larkin¹, Carol L Hodgson^{2

3}

Affiliations

¹ Allied Health Department, The Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
² Australian and New Zealand Intensive Care-Research Center, School of Public Health and Preventive Medicine, Monash University, Parkville, VIC 3050, Australia.
³ Physiotherapy Department, The Alfred Hospital, Melbourne, VIC 3004, Australia.
⁴ Department of Intensive Care, The Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
⁵ Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
⁶ Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC 3010, Australia.
⁷ The Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia.

Abstract

Importance: Patients with aneurysmal subarachnoid hemorrhage (aSAH) represent a cohort with limited evidence to guide mobilization practices.

Objective: The objective was to describe acute mobilization practices, outcomes, and barriers to mobilization in patients following aSAH.

Design: The design of the study was a single-center prospective, observational study.

Setting: This study was conducted in the acute ward and intensive care unit of a tertiary neurosurgical referral center.

Participants: Participants were adult (≥18 years) patients post-aSAH with secured aneurysms.

Exposure: Mobilization practices were delivered during physical therapist sessions up to 14 days post-aneurysm repair.

Main outcomes and measures: Severity was classified using the World Federation of Neurological Surgeons scale, dichotomizing into "good" (Grade I to II) and "poor" (Grade III to V) clinical status. Mobilization outcomes were measured using the Mobility Scale for Acute Stroke (MSAS), with independent walking assessed.

Results: A total of 102 patients participated with 69 (67.6%) classified as "good" grade and 90 (88.2%) of patients mobilized within the first 14 days. Data were collected from 603 planned mobilization sessions, with barriers to mobilization encountered in 193 (32.0%) of these sessions, primarily due to neurological instability (n = 80, 41.5%) and hemodynamic instability (n = 43, 22.3%). Overall, the highest median MSAS score achieved was 32 (IQR = 10 to 36). By 2 weeks, 65.2% of patients with a "good" clinical status walked independently versus 12.9% in the "poor" group.

Conclusions: While most patients mobilized, physiological instability commonly prevented mobilization activities. Independent walking by 2 weeks was significantly more common in patients with "good" clinical status. These findings underline the importance of careful screening and monitoring during mobilization in the acute period.

Relevance: This study underscores the need for further research into optimal mobilization strategies for improving outcomes in patients with aSAH.

Keywords: Early mobilization; aneurysmal subarachnoid haemorrhage; independent walking; mobilization barriers.

Publication types

Observational Study

MeSH terms

Adult
Aged
Early Ambulation* / methods
Female
Humans
Male
Middle Aged
Prospective Studies
Subarachnoid Hemorrhage* / rehabilitation
Subarachnoid Hemorrhage* / surgery
Treatment Outcome