Oral Presentation Asia Pacific Stroke Conference 2024

Early Mobility Training After Intracerebral Haemorrhage: What, How and When? (107518)

Emily R Ramage 1 2 3 , Ruby Lipson-Smith 1 4 , Jussara Baggio 5 , Leonid Churilov 2 , Candice Delcourt 6 7 8 , Simone Dorsch 9 10 , Gill Edmonds 11 12 , Dorcas Gandhi 13 , Michelle Hiddleston 14 , Mark Hindson 15 , Liyana Inche Mat  16 , Tina Kaffenberger 1 , Helen Kavanagh 17 18 , Chen Lin 19 20 , Tiing Lio 21 , Iara Maso 22 , Luana Miranda 23 , Aden Mullens 24 , Brooke Parsons 1 , Brian Silver 25 , Louise Suttie 24 , Shamala Thilarajah 26 27 , Teresa Ullberg 28 , Wan WZ Asyraf 29 , Mary Weir McDonnell 30 , Julie Bernhardt 1
  1. Florey Institute, Heidelberg, AUSTRALIA, Australia
  2. University of Melbourne, Parkville, VIC, Australia
  3. Western Health, St Albans, VIC, Australia
  4. The MARCS Institute for Brain, Behaviour and Development,, Western Sydney University, Sydney, VIC, Australia
  5. Federal University of Alagoas, Medical School , Arapiraca, Alagoas, Brazil
  6. The George Institute for Global Health, Sydney, NSW, Australia
  7. University of New South Wales, Sydney, NSW, Australia
  8. Macquarie University, Macquarie Park, NSW, Australia
  9. ACU, Sydney, NSW, Australia
  10. Stroke Ed, Sydney, NSW, Australia
  11. Fiona Stanley Hospital, Murdoch, WA, Australia
  12. Fiona Stanley Hospital, Murdoch, WA, Australia
  13. Christian Medical College & Hospital, LudhianaIndia, India
  14. Barwon Health, Geelong, VIC, Australia
  15. Austin Health, Heidelberg, Victoria, Australia
  16. Universiti Putra Malaysia, Selangor, Malaysia
  17. St James' Hospital, Dublin, Ireland
  18. Clinical Design & Innovation Heal Service Executive, Dublin, Ireland
  19. The University of Alabama at Birmingham, Birmingham, USA
  20. Birmingham VA Medical Center, Birmingham, USA
  21. St John of God Midland Public and Private Hospitals, Midland, WA, Australia
  22. Roberto Santos General Hospital, Stroke Unit, Salvador, Brazil
  23. São Paulo State University, Botucatu, Brazil
  24. Consumer Partner, Australia
  25. UMass Chan Medical School, Worcester, USA
  26. Singapore Institute of Technology, Singapore
  27. Singapore General Hospital, Singapore
  28. Lund University, Sweden, Malmö, Sweden
  29. Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan, Kuala Lumpur, Malaysia
  30. Saolta University Health Care Group, Mayo University Hospital, Castlebar, Ireland

Background and aims: While stroke guidelines guard against intensive early mobility training, clinicians want further guidance for early mobility training after stroke. Evidence for early mobility training in ischaemic stroke is growing, however, clinical trials evaluating early mobility training in haemorrhagic stroke are lacking. The largest international trial in early mobility training identified people with intracerebral haemorrhage may be more vulnerable to early mobility training. Our international collaboration aims to build guidance for early mobility training after intracerebral haemorrhage.

Method: Twenty-six collaborators including neurologists, nurses, physiotherapists, people with lived experience of stroke and researchers co-produced an evidence and expert informed clinical protocol for early mobility training after intracerebral haemorrhage ready for evaluation. Value focused thinking was used to optimise decision making during a series of iterative workshops run via videoconference across nine countries including low-middle and high income settings.

Results: We identified 10 key parameters required to assess the potential safety and effectiveness of initiating early mobility training after intracerebral haemorrhage; monitoring requirements during early training; and, ranked key outcomes and data points to evaluate the training. All elements have been protocolised into a decision matrix alongside guidance for implementation and patient, family and caregiver engagement.

Conclusion: A one-size-fits-all approach to timing and dosage of early mobility training should not be applied to people after intracerebral haemorrhage. We developed expert and evidence informed training pathways for intracerebral haemorrhage phenotypes with different risk profiles which are ready for evaluation.