Structured mobilisation protocol and early rehabilitation outcomes in patients with severe subarachnoid hemorrhage: a retrospective study

Background/Aims: Subarachnoid haemorrhage results from ruptured cerebral aneurysms, and rapid therapeutic intervention is critical for improved patient outcomes. Early mobilisation in severe cases is considered beneficial for improving the prognosis; however, studies supporting its effectiveness remain limited. The aim of this study was to assess the preliminary effectiveness of a mobilisation protocol for patients with severe subarachnoid haemorrhage. Methods A total of 66 patients with subarachnoid haemorrhage were categorised into a mild (n=45) or severe group (n=21). The severe group was further divided into pre-protocol (August 2011 to September 2020) and protocol (October 2020 to March 2022) groups. The protocol was advanced through bed level, bed-raised, sitting, and wheelchair in 2-day steps. On the second day of the intervention, neurological and systemic assessments and overload criteria were reviewed. Mobilisation was paused and reattempted under the same conditions the next day if any criteria for pausing or overload were met. Mobilization progress, defined as the most advanced stage achieved per day up to wheelchair use, was set as the primary outcome. ICU Mobility Scale scores at discharge and the incidence of cerebral vasospasm were evaluated as secondary outcomes Results Patients in the severe group had longer durations of ventilator use and intensive care unit stay, as well as significantly lower ICU Mobility Scale scores at discharge (median 2 days [interquartile range: 0–5.0 days]) than the mild group (median 4.0 days [interquartile range: 2.0–8.0 days]; P<0.05). The time required for mobilisation to wheelchair use was significantly shorter in the protocol implementation group (13.1 ± 5.0 days) compared with the non-protocol group (28.0 ± 3.1 days; P<0.05), indicating that the protocol facilitated early mobilisation. There was no significant difference in the incidence of cerebral vasospasm between the protocol group (5/6 patients, 83.3%) and the non-protocol group (6/15 patients, 40.0%; P=0.07). Conclusions There was a significantly faster mobilisation rate in the protocol group, suggesting that the protocol contributes to the promotion of early mobilisation. Further large-scale studies are required to validate these findings and explore further clinical implementation. Implications for practice For allied health professionals, this study highlights the importance of using a structured mobilisation protocol to guide rehabilitation in patients with severe subarachnoid haemorrhage. A standardised, stepwise approach facilitates early mobilisation up to wheelchair use while maintaining safety, reduces uncertainty about when to progress, and promotes consistent decision-making across disciplines. This protocol can therefore enhance interdisciplinary collaboration, support functional monitoring using outcomes such as ICU Mobility Scale scores, and contribute to more effective and coordinated rehabilitation practice in the ICU.