Brian Silver1, Tariq Hamid2, Muhib Khan3, Mario Di Napoli4, Reza Behrouz5, Gustavo Saposnik6, Jo-Ann Sarafin7, Susan Martin8, Majaz Moonis9, Nils Henninger10, Richard Goddeau9, Adalia Jun-O'Connell9, Shawna M Cutting11, Ali Saad11, Shadi Yaghi12, Wiley Hall13, Susanne Muehlschlegel13, Raphael Carandang13, Marcey Osgood13, Bradford B Thompson14, Corey R Fehnel15, Linda C Wendell16, N Stevenson Potter14, James M Gilchrist17, Bruce Barton18. 1. Department of Neurology, University of Massachusetts Medical School, Worcester, MA, United States of America. Electronic address: Brian.Silver@umassmed.edu. 2. Department of Neurology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, United States of America. 3. Neuroscience Institute, Spectrum Health, Grand Rapids, MI, United States of America. 4. Department of Neurology and Stroke Unit, San Camillo de' Lellis General Hospital, Rieti, Italy. 5. Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, TX, United States of America. 6. Outcomes Research and Decision Neuroscience Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. 7. Department of Neurology, Alpert Medical School of Brown University, Providence, RI, United States of America; Department of Nursing, Rhode Island Hospital, Providence, RI, United States of America. 8. Rhode Island Hospital Rehabilitation Services, Providence, RI, United States of America. 9. Department of Neurology, University of Massachusetts Medical School, Worcester, MA, United States of America. 10. Department of Neurology, University of Massachusetts Medical School, Worcester, MA, United States of America; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States of America. 11. Department of Neurology, Alpert Medical School of Brown University, Providence, RI, United States of America. 12. Department of Neurology, NYU Langone Medical School, Brooklyn, NY, United States of America. 13. Department of Neurology, University of Massachusetts Medical School, Worcester, MA, United States of America; Departments of Anesthesia/Critical Care & Surgery, University of Massachusetts Medical School, Worcester, MA, United States of America. 14. Department of Neurology, Alpert Medical School of Brown University, Providence, RI, United States of America; Department of Neurosurgery, Alpert Medical School of Brown University, Providence, RI, United States of America. 15. Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America. 16. Department of Neurology, Alpert Medical School of Brown University, Providence, RI, United States of America; Department of Neurosurgery, Alpert Medical School of Brown University, Providence, RI, United States of America; Division of Medical Education, Alpert Medical School of Brown University, Providence, RI, United States of America. 17. Department of Neurology, Southern Illinois University School of Medicine, Springfield, Il, United States of America. 18. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America.
Abstract
BACKGROUND: The practice of ≥24 h of bed rest after acute ischemic stroke thrombolysis is common among hospitals, but its value compared to shorter periods of bed rest is unknown. METHODS: Consecutive adult patients with a diagnosis of ischemic stroke who had received intravenous thrombolysis treatment from 1/1/2010 until 4/13/2016, identified from the local ischemic stroke registry, were included. Standard practice bed rest for ≥24 h, the protocol prior to 1/27/2014, was retrospectively compared with standard practice bed rest for ≥12 h, the protocol after that date. The primary outcome was favorable discharge location (defined as home, home with services, or acute rehabilitation). Secondary outcome measures included incidence of pneumonia, NIHSS at discharge, and length of stay. RESULTS: 392 patients were identified (203 in the ≥24 h group, 189 in the ≥12 h group). There was no significant difference in favorable discharge outcome in the ≥24 h bed rest protocol compared with the ≥12 h bed rest protocol in multivariable logistic regression analysis (76.2% vs. 70.9%, adjusted OR 1.20 CI 0.71-2.03). Compared with the ≥24 h bed rest group, pneumonia rates (8.3% versus 1.6%, adjusted OR 0.12 CI 0.03-0.55), median discharge NIHSS (3 versus 2, adjusted p = .034), and mean length of stay (5.4 versus 3.5 days, adjusted p = .006) were lower in the ≥12 h bed rest group. CONCLUSION: Compared with ≥24 h bed rest, ≥12 h bed rest after acute ischemic stroke reperfusion therapy appeared to be similar. A non-inferiority randomized trial is needed to verify these findings.
BACKGROUND: The practice of ≥24 h of bed rest after acute ischemic stroke thrombolysis is common among hospitals, but its value compared to shorter periods of bed rest is unknown. METHODS: Consecutive adult patients with a diagnosis of ischemic stroke who had received intravenous thrombolysis treatment from 1/1/2010 until 4/13/2016, identified from the local ischemic stroke registry, were included. Standard practice bed rest for ≥24 h, the protocol prior to 1/27/2014, was retrospectively compared with standard practice bed rest for ≥12 h, the protocol after that date. The primary outcome was favorable discharge location (defined as home, home with services, or acute rehabilitation). Secondary outcome measures included incidence of pneumonia, NIHSS at discharge, and length of stay. RESULTS: 392 patients were identified (203 in the ≥24 h group, 189 in the ≥12 h group). There was no significant difference in favorable discharge outcome in the ≥24 h bed rest protocol compared with the ≥12 h bed rest protocol in multivariable logistic regression analysis (76.2% vs. 70.9%, adjusted OR 1.20 CI 0.71-2.03). Compared with the ≥24 h bed rest group, pneumonia rates (8.3% versus 1.6%, adjusted OR 0.12 CI 0.03-0.55), median discharge NIHSS (3 versus 2, adjusted p = .034), and mean length of stay (5.4 versus 3.5 days, adjusted p = .006) were lower in the ≥12 h bed rest group. CONCLUSION: Compared with ≥24 h bed rest, ≥12 h bed rest after acute ischemic stroke reperfusion therapy appeared to be similar. A non-inferiority randomized trial is needed to verify these findings.
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