Very Early Mobilization After Stroke Fast-Tracks Return to Walking

Abstract

Background and Purpose-Regaining functional independence is an important goal for people who have experienced stroke. We hypothesized that introducing earlier and more intensive out-of-bed activity after stroke would reduce time to unassisted walking and improve independence in activities of daily living. Methods-A Very Early Rehabilitation Trial (AVERT) was a phase II randomized controlled trial. Patients with confirmed stroke (infarct or hemorrhage) admitted Ͻ24 hours after stroke and who met physiological safety criteria were eligible. Patients randomized to the very early and intensive mobilization group were mobilized within 24 hours of stroke and at regular intervals thereafter. Control patients received standard stroke unit care. The primary outcome for this analysis was the number of days required to return to walking 50 m unassisted. Secondary outcomes were the Barthel Index and Rivermead Motor Assessment at 3 and 12 months after stroke. Results-Seventy-one stroke patients with a mean age of 74.7 years were recruited from 2 hospitals. Adjusted Cox regression indicated that very early and intensive mobilization group patients returned to walking significantly faster than did standard stroke unit care controls (Pϭ0.032; median 3.5 vs 7.0 days). Multivariable regression revealed that exposure to very early and intensive mobilization was independently associated with good functional outcome on the Barthel Index at 3 months (Pϭ0.008) and on the Rivermead Motor Assessment at 3 (Pϭ0.050) and 12 (Pϭ0.024) months. Key Words: acute care Ⅲ cerebrovascular disease Ⅲ functional recovery Ⅲ randomized controlled trials Ⅲ rehabilitation A s a consequence of focal brain ischemia or hemorrhage, stroke can have both immediate and ongoing physical effects. Within 12 months of stroke, one third of stroke patients will die and another third are left with disability, restricted in performing simple activities of daily living (ADLs) and requiring some kind of assistance. 1 Of all recovery goals, improved walking function is the one most often expressed by patients with stroke. 2 The rate of physical recovery is not linear; the most rapid improvement occurs within the first 6 months after stroke. 3,4 In a study of 976 acute stroke patients, Wade and Hewer 5 reported some recovery between 3 weeks and 6 months in almost all patients, and by 6 months, approximately half of the survivors had regained functional independence. In another large study, approximately two thirds of patients were unable to walk without assistance in the first week after stroke. 6 Among those initially unable to walk, 95% of patients recovered within the first 3 months, with leg paresis strongly associated with the rate of recovery. In addition to stroke severity, 7,8 increasing age 8,9 and diabetes 8,10 are factors that have been associated with a lower rate and extent of functional recovery after stroke. Conclusions-EarlierBoth the speed and extent of recovery are important to survivors of stroke, yet research examining the efficacy of interventions...

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“…31 Recent studies in rodents have shown that this recovery is most likely because of acivitydriven changes in BDNF. 19 In the present study, we failed to see any significant elevation in BDNF levels after stroke, indicating that the endogenous neuroplastic mechanisms involved in improving motor functions in young, are lacking or impaired in aged mice.…”

A Very Early Rehabilitation Trial after stroke (AVERT): a Phase III, multicentre, randomised controlled trial

“…17 She also demonstrated that there was considerable variation of opinion and clinical uncertainty among health-care professionals about the value of very early mobilisation (VEM). 23 These studies led to the AVERT Phase II safety and feasibility randomised controlled trial (RCT) 25,26 and the closely related Very Early Rehabilitation or Intensive Telemetry After Stroke (VERITAS) trial 27 carried out in Glasgow by Professor Peter Langhorne. These trials indicated that VEM was feasible and in the case of AVERT Phase II could be carried out within 24 hours of stroke onset.…”

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

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