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Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT)

Bernhardt, Julie, Churilov, Leonid, Ellery, Fiona, Collier, Janice, Chamberlain, Jan, Langhorne, Peter, Lindley, Richard I., Moodie, Marj, Dewey, Helen, Thrift, Amanda G. and Donnan, Geoff 2016, Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT), Neurology, vol. 86, no. 23, pp. 2138-2145, doi: 10.1212/WNL.0000000000002459.

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Title Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT)
Author(s) Bernhardt, Julie
Churilov, Leonid
Ellery, Fiona
Collier, Janice
Chamberlain, Jan
Langhorne, Peter
Lindley, Richard I.
Moodie, Marj
Dewey, Helen
Thrift, Amanda G.
Donnan, Geoff
Journal name Neurology
Volume number 86
Issue number 23
Start page 2138
End page 2145
Total pages 9
Publisher American Academy of Neurology
Place of publication Minneapolis, Minn.
Publication date 2016-06-07
ISSN 0028-3878
1526-632X
Summary 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.
Notes Prepared on behalf of the AVERT Collaboration Group
Language eng
DOI 10.1212/WNL.0000000000002459
Field of Research 110999 Neurosciences not elsewhere classified
1103 Clinical Sciences
1109 Neurosciences
1702 Cognitive Science
Socio Economic Objective 920111 Nervous System and Disorders
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, American Academy of Neurology
Free to Read? Yes
Use Rights Creative Commons Attribution Non-Commercial No-Derivatives licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30081737

Document type: Journal Article
Collections: Population Health
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.