Abstract 3160: Tolerance to a Tilt Table Standing Protocol In an Acute Stroke-Unit Setting: A Pilot Study
Background: objective was set to describe and examine physiological and self-reported indices of tolerance of a standing tilt table protocol (STTP) among patients following an acute stroke.
Design: Prospective, observational pilot study of patients admitted to a stroke unit of a single academic medical center.
Methods: A clinical protocol for the use of the tilt table was developed and applied to subjects in the acute phase following a stroke. The protocol involved a step-wise process to gradually raise the subject into a standing position with lower extremities in a weight bearing position on the tilt table platform, at 10 degree intervals from 60 to 90 degrees. The STTP clinical indices of tolerance were operationally defined as: Systolic blood pressure (SBP) maintained within 20 mmHg of baseline, diastolic blood pressure (DBP) maintained within 10 mmHg of baseline, heart rate (HR) maintained within 10 beats per minute of baseline, oxygen saturation (SpO2) maintained at 90% or above while on supplemental O2 or room air, absence of pallor. Subjective indices of tolerance were operationally defined as: rating of perceived exertion (RPE) < 15 per Borg Rating of Perceived Exertion Scale, pain < 5 using a numerical pain rating scale ranging from 0 to 10, and absence of angina, dizziness, nausea, dyspnea, or request to discontinue the STTP. No single measure was considered to be of primary importance, and any value falling outside the predetermined parameter was considered indicative of intolerance. Overall, tolerance of the STTP was defined as the ability to sustain 60 degrees or greater of tilt table inclination (minimum of 87% total weight bearing) for a minimum 5 minutes, without signs or symptoms of intolerance. Specifically, frequencies of the highest angle achieved, the duration of standing time tolerated, and physiologic response were recorded.
Results: Thirty-six patients with ischemic or hemorrhagic stroke (22 females, 14 males) aged 24 to 87 years (62 + 16 years) enrolled. Fifty three percent of subjects (N = 19) attained 60 degrees or higher on the standing tilt table. Ten subjects were unable to achieve 45 degrees. Subjects tolerated a mean total standing time at or above 60 degrees of 8.9 + 7.2 minutes. All subjects met tolerance criteria for dyspnea, pain, pallor, perceived effort, and nausea at 60 degrees or higher. All subjects were tolerant by heart rate criteria at 70, 80 and 90 degrees; 96% were tolerant at 60 degrees. For diastolic blood pressure, tolerance ranged from 72% (80 degrees) to 90% (70 degrees). For systolic blood pressure, tolerance ranged from 84% (70 degrees) to 100% (90 degrees). Oxygen saturation tolerance was achieved in 100% of subjects at each angle.
Conclusion: This pilot study suggests that use of a tilt table is well tolerated among patients in the acute stroke phase, and may be an effective tool for introducing early mobilization to a medically fragile patient population.
- © 2012 by American Heart Association, Inc.