The prevalence of orthostatic hypotension during physiotherapy treatment in patients with an acute spinal cord injury.

STUDY
DESIGN: Prospective, observational.
OBJECTIVES: To investigate the prevalence of orthostatic hypotension (OH), its associated signs and symptoms, and the resulting limitation to treatment during initial physiotherapy treatments involving mobilisation for patients with an acute spinal cord injury (SCI).
SETTING: Spinal Injuries Units, Royal Adelaide Hospital and Hampstead Rehabilitation Centre, Adelaide, South Australia.
METHODS: Fourteen of 17 consecutive patients admitted with an acute SCI completed the study. Non-invasive measurement of systolic and diastolic blood pressure (BP), heart rate and percutaneous oxygen saturation were recorded during a 10-min baseline period with the patient resting in supine, and then at 1-min intervals for the first 10 min of physiotherapy treatments that involved mobilisation (ie sitting or standing). Following cessation of the treatment and return to the supine position, further measurements were made immediately and following 5 min of rest. Visual signs and patient reported symptoms of OH and any perceived limitation to therapy were also recorded. The study period comprised the first 10 physiotherapy treatments that involved mobilisation.
RESULTS: BP changes indicative of OH occurred during 73.6% of mobilisation treatments. Of these treatments, accompanying signs and symptoms of OH were noted on 58.9% of occasions and were perceived as limiting treatment on 43.2% of occasions. Patients with tetraplegia had a higher prevalence of OH and a greater fall in BP than patients with paraplegia, irrespective of whether their lesion was complete or incomplete.
CONCLUSION: Blood pressure changes indicative of OH and accompanying signs and symptoms of OH are a common occurrence during the physiotherapy mobilisation of patients with an acute SCI.