Early Out-of-bed Rehabilitation after Endovascular Thrombectomy: A Randomized Controlled Trial.

Abstract

To determine whether out-of-bed rehabilitation within 48 hours after endovascular thrombectomy (EVT) for large-vessel occlusion improves functional outcomes and motor recovery, and to evaluate safety of neurological and immobility-related complications. A randomized controlled trial. A tertiary medical center. Forty-two patients underwent EVT for anterior-circulation large-vessel occlusion and were stable within 48 hours after reperfusion were randomized to Early out-of-bed Mobilization (EM; n = 21) or Usual Care (UC; n = 21). EM group initiated progressive out-of-bed activities within 48 hours, and UC group received conventional rehabilitation within 7 days. Both groups received 20-30-minute sessions twice daily, five days per week. The primary outcome was modified Rankin Scale (mRS) at 3 months. Secondary outcomes included mRS at 1 month, Barthel Index, and Fugl-Meyer Assessment for the upper extremity (FMA-UE) and lower extremity (FMA-LE) at 1 and 3 months. Neurological and immobility-related adverse events were monitored for 3 months. At 3 months, no significant between-group difference in mRS was observed. Barthel Index scores were comparable at both follow-up time points. Exploratory analyses suggested greater motor recovery in EM group. The mean between-group difference in ΔFMA-UE was 7.13 points (95% confidence interval [CI] -0.98 to 15.24; p = 0.083) at 1 month and 12.20 points (95% CI 1.21 to 23.19; p = 0.031) at 3 months, while the ΔFMA-LE difference was 5.14 points (95% CI 1.45 to 8.84; p = 0.008) at 1 month and 6.33 points (95% CI 1.06 to 11.59; p = 0.020) at 3 months. Neurological and immobility-related adverse events were infrequent and comparable. Early out-of-bed mobilization initiated within 48 hours after EVT was not associated with improved overall functional outcome but was safe and associated with significantly greater upper- and lower-extremity motor recovery compared with usual care.