Journal
NEUROLOGY
Volume 86, Issue 23, Pages 2138-2145Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0000000000002459
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Funding
- National Health and Medical Research Council (NHMRC) of Australia [386201, 1041401]
- Chest Heart and Stroke Scotland [Res08/A114]
- Northern Ireland Chest Heart and Stroke
- Singapore Health [SHF/FG401P/2008]
- Stroke Association, UK [TSA2009/09]
- National Institute of Health Research, UK [12/01/16]
- Victorian government
- Chest Heart and Stroke Scotland [Res08/A114] Funding Source: researchfish
- National Institute for Health Research [12/01/16] Funding Source: researchfish
- Stroke Association [TSA2009/09] Funding Source: researchfish
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Objective:Our prespecified dose-response analyses of A Very Early Rehabilitation Trial (AVERT) aim to provide practical guidance for clinicians on the timing, frequency, and amount of mobilization following acute stroke.Methods:Eligible patients were aged 18 years, had confirmed first (or recurrent) stroke, and were admitted to a stroke unit within 24 hours of stroke onset. Patients were randomized to receive very early and frequent mobilization, commencing within 24 hours, or usual care. We used regression analyses and Classification and Regression Trees (CART) to investigate the effect of timing and dose of mobilization on efficacy and safety outcomes, irrespective of assigned treatment group.Results:A total of 2,104 patients were enrolled, of whom 2,083 (99.0%) were followed up at 3 months. We found a consistent pattern of improved odds of favorable outcome in efficacy and safety outcomes with increased daily frequency of out-of-bed sessions (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.09 to 1.18, p < 0.001), keeping time to first mobilization and mobilization amount constant. Increased amount (minutes per day) of mobilization reduced the odds of a good outcome (OR 0.94, 95% CI 0.91 to 0.97, p < 0.001). Session frequency was the most important variable in the CART analysis, after prognostic variables age and baseline stroke severity.Conclusion:These data suggest that shorter, more frequent mobilization early after acute stroke is associated with greater odds of favorable outcome at 3 months when controlling for age and stroke severity.Classification of evidence:This study provides Class III evidence that shorter, more frequent early mobilization improves the chance of regaining independence after stroke.
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