A Very Early Rehabilitation Trial for Stroke (AVERT)

Abstract

Background and Purpose-Very early rehabilitation, with an emphasis on mobilization, may contribute to improved outcomes after stroke. We hypothesized that a very early rehabilitation protocol would be safe and feasible. Methods-We performed a randomized, controlled trial with blinded outcome assessment. Patients at Ͻ24 hours after stroke were recruited from 2 Melbourne metropolitan stroke units. Patients were randomly assigned to receive standard care (SC) or SC plus very early mobilization (VEM) until discharge or 14 days (whichever was sooner). The primary safety outcome was the number of deaths at 3 months. The primary feasibility outcome was a higher "dose" of mobilization achieved in VEM. Secondary safety outcomes included adverse events (including falls and early neurologic deterioration), compliance with physiologic monitoring criteria, and patient fatigue after interventions. Secondary feasibility outcomes included "contamination" of standard care. Results-Overall, 18% of patients screened were suitable for recruitment. Seventy-one patients were recruited and randomized, with 2 dropouts by 12 months. The majority experienced ischemic strokes (87%). The group meanϮSD age was 74.7Ϯ12.5 years, and 58% (nϭ41) had a National Institutes of Health Stroke Scale score Ͼ7. There was no significant difference in the number of deaths between groups (SC, 3 of 33; VEM, 8 of 38; Pϭ0.20). Almost all deaths occurred in patients with severe stroke. Secondary safety outcomes were similar between groups. The intervention protocol was successfully delivered, achieving VEM dose targets (double SC, Pϭ0.003) and faster time to first mobilization (PϽ0.001). Conclusions-VEM

Feasibility of Early Physical Therapy Program In-Hospital Patients with Acute Ischemic Stroke

“…A number of authors propose indications and recommend early start of the rehabilitation process (between 24 and 48 hours after the accident) to prevent and minimize the risk of extracerebral complications and promote functional recovery [1][2][3][4]. It is believed that the aggressive detection and treatment of secondary complications, including inactivity related complications, contribute to benefits and that the majority of complications during the acute period may be avoided through early inclusion of physical therapy [5].…”

Rehabilitation and Plasticity

“…In humans, using high-intensity constraint induced movement therapy (CIMT, 3 hours of training based on shaping principles plus immobilizing the intact limb for 90% of the waking hours for 10 days) starting around 10 days after stroke results in adverse outcomes as compared with standard occupational therapy and standard CIMT (two hours of shaping plus 6 hours of immobilization per day Dromerick et al 2009). In contrast, Bernhardt and coworkers suggested that early -within 24 hours -mobilization, i.e., getting the patient out of bed, improves the outcome three months after the stroke (Bernhardt et al 2008). This finding awaits confirmation in a larger sample.…”

The role of evidence-based medicine in the neurorehabilitation: the innovative technologies (a review)

“…В настоящее время идет крупное рандомизиро-ванное контролируемое исследование AVERT, по-священное оценке эффективности и экономиче-ской целесообразности ранней мобилизации паци-ентов после инсульта [2]. Мобилизация начинается в течение 24 ч от начала инсульта и продолжается каждый день первые 14 дней или до момента выпи-ски.…”