Abstract TP182: Physical Therapy/Occupational Therapy Evaluation Within the First 24-Hours for Patients Who Have Received Intravenous Alteplase

• Published in: Stroke (1970) Vol. 50; no. Suppl_1
• Main Authors: Sinogui, Cynthia, Barzo, Melissa, Zrelak, Patricia, Murphy, Ryan, Jennings, Amber, Hartman, Jonathan
• Format: Journal Article
• Language: English
• Published: 01.02.2019
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.50.suppl_1.TP182

Abstract only Background: Designated Stroke Centers are required by The Joint Commission to evaluate all acute ischemic stroke (AIS) patients for rehabilitation prior to discharge. Timing of this evaluation is controversial. Purpose: To evaluate the feasibility and safety of having a Physical Therapist (PT) or Occupational Therapist (OT) evaluate AIS patients within 24 hours of alteplase administration. Methods: Based on a comprehensive literature review, various committee discussions and agreement, the PT/OT team initiated evaluations within 24-hours for AIS patients treated with alteplase. The target post-alteplase evaluation time was 12-hours. Medical stability was determined by the physician as evidenced by an initial request for PT/OT evaluation. Prior to the evaluation, the therapist performed a thorough chart review. Patients with unstable vital signs, a fluctuating neurological assessment, and/or inability to participate in therapies were excluded. During the therapy evaluation, reassessment was ongoing. If any adverse change was observed, the evaluation was immediately stopped, the patient placed back in bed, and the primary nurse and/or physician notified. Results: A baseline review of data was performed. In 2016, 77 patients received alteplase, none of whom were evaluated within 24-hours following alteplase administration. Evaluations within 24 hours post-alteplase began in mid-March 2017 and continued through July 2018. A total of 103 patients received alteplase during this period, of whom 11 patients met initial exclusion criteria. Of these, 83% (76/92) were seen within the initial 24-hour timeframe. All patients reviewed and evaluated by the team were in the Intensive Care Unit. No mobility-associated complication or adverse neurologic change occurred during therapy evaluations or because of mobilization within the initial 24-hours. Conclusion: PT/OT neurological evaluations within 24-hours of alteplase administration did not result in adverse events or complications. Although difficult to quantify, therapy staff determined this change in practice was beneficial to patients as it allowed for earlier mobilization and initiation of the rehabilitation plan.