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Neurology. 2016 Jun 7;86(23):2138-45. doi: 10.1212/WNL.0000000000002459. Epub 2016 Feb 17.

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

Collaborators (1184)

Bernhardt J, Churilov L, Collier J, Dewey H, Donnan G, Ellery F, Langhorne P, Lindley R, Moodie M, Parsons B, Thrift A, Donnan G, Dewey H, Bernhardt J, Langhorne P, Moodie M, Parsons B, Investigators MIs M, Indredavik B, Askim T, Bath P, Bladin C, Reid C, Read S, Said C, Middleton S, Frayne J, Srikanth V, Bernhardt AJ, Dewey H, Bernhardt J, Donnan G, Thrift A, Carter R, Lindley R, Bernhardt J, Donnan G, Lindley R, Thrift A, Langhorne P, Moodie M, Dewey H, Churilov L, Langhorne P, Langhorne P, Wu O, Bernhardt J, Claire Ritchie MW, Smith L, Langhorne P, Wu O, Ashburn A, Rodgers H, Bernhardt J, Langhorne P, Ashburn A, Bernhardt J, Rogers H, Wu O, Lennon S, Lennon S, Power M, Bernhardt J, Hameed S, Hameed S, Pavanni R, Lim P, Bernhardt J, Tan D, Churilov L, Brewer T, Collier J, Haritos N, Leong E, Li C, NayWin C, Nicol M, Olenka L, Quang LC, Moodie M, Carter R, Hope S, Sheppard L, Teo KT, Wu O, Cumming T, Linden T, Borschmann K, Chamberlain J, Collier J, Cumming T, Ellery F, Occhiodoro T, Palfreeman H, Purvis T, Sirgo B, Tiliacos N, Van Holsteyn J, Zhao H, Armstrong B, Craig L, Graham F, Legg L, Morrison R, Moorhead H, O'Donohue L, Rogers S, Smith M, Forshaw D, Fitzgerald J, Hibbert E, Melling R, Petrolo S, Purvis T, Williamson MIs H, Adams P, Augoustakis L, Batcheler S, Berney S, Cobani V, Cohen B, Dewey H, Gangi S, Giofre N, Gordon C, Hegarty L, Hindson M, Horvath F, Kalinowski S, Kleine A, Kramer S, Lawrence J, Lindquist S, Logan N, Macdonell A, Matlioski J, McDonough N, McLennan S, McNamee M, Miller L, Nall C, Nelson E, Ng K, Nicholas Z, Nunn C, Owen K, Plant E, Proud L, Quah D, Rodway K, Sertori S, Sheldon V, Sherry L, Speare S, Stansfeld K, Studden N, Teoh Z, Twist L, Velupillai G, Walker L, Wall K, Warwick A, Wharrie R, Wilson J, Worboys H, Young D, Ancliffe Mi J, Bryant M, Doran B, Field M, Fogliani P, Haber A, Hankey G, Hendrie D, Jackaman V, Jacobsen A, Jose S, Lim R, Louis R, Nanthakumar S, Pain S, Power A, Rappeport B, Reynolds J, Smith L, Tombe S, Wesseldine A, West T, Clarke K, Maccanti H, Marr L, Plumb S, Quiney J, Werner MIs L, Abeykoon E, Apirutvorrachod W, Attard L, Behanan S, Brown D, Buchanan K, Butler D, Camac M, Davis S, Diocera D, Gan N, Gendre C, Germaine J, Hand P, Maurenbrecher L, McCulloch J, Mcritchie S, Ong M, Pachett R, Pesavento L, Power H, Reilly R, Sawers M, Silva G, Stevens C, Taylor L, Timms T, Ugalde M, Vardy A, Wallace J, Walsh S, Whatley E, Winter E, Baxter M, Davis M, Sundararajan MIs L, Butler E, Caspers K, Coulter E, Shaw S, Kent F, Lack H, Leavold F, Lord J, Martin-Francisco J, Mohanraj R, Nelson R, O'Neill T, Otto R, Parker J, Rees V, Stevens B, Chen Mi R, Lindley R, Bindra J, Dongre R, Downey N, Ferris M, Gibson L, Gonzalez R, Kinniburgh M, Lazaridou M, McCormack D, Singh R, Stepney A, Tria Y, Bainbridge K, Killey B, Sheedy MIs R, Aitchison O, Bray L, Clatworthy K, Coghill S, Collins M, Cornwall L, Dow J, Gates P, Gillett S, Johnson N, Joseph S, Kopelke K, Lam R, Levy R, Lloyd N, Logan S, McPherson G, Newth M, Parsons C, Powles K, Rebis M, Samakowidic T, Sanders L, Savickas S, Shrimpton J, Smith H, Smith L, Spehr J, Summers J, Taylor G, Thackeray M, Wilkinson B, Richardson Mi K, Frayne J, Barber E, Bode L, Brakey A, Chand K, Christin P, Crook G, Delrosario-Kelly D, Descallar R, Deutsch A, Easo S, Farquhar M, Fergus P, Ford J, Hamson E, Hlaing M, Hope E, Lacivita J, Laurenson J, Lock K, Ly N, McKay K, Mill C, Moloney K, Price L, Terry T, Tyers A, Willems S, Woolstencroft R, Crawshaw N, Luker J, Wood C, Choat MIs S, Archer C, Benham D, Billinger M, Bronca M, Curchin S, Dickie C, Dixon M, Douglass D, Enomoto M, Ernst K, Fries L, George S, Green E, Hamilton L, Harris Z, Heard T, Hunt G, Jamieson N, Mackenzie M, McKearney H, Oermann B, O'Reilly C, Pearson T, Reid N, Rodda L, Scutcheon D, Simons C, Smith R, Tait L, Troake J, Usher D, Mackey L, Wijeratne MIs T, Abela C, Ashoka S, Chen C, Cheng T, Chong V, Cooke S, Fok A, Galang L, Grant C, Karageorge S, Kat K, Keo L, Lee B, Luscombe A, Mackay J, Minett M, Mizen J, Nim P, Nunlist N, Patel V, Pathirage M, Paton A, Pombuena M, Rathnayake N, Rhodes L, Sequeira M, Smart S, Somaratne S, Maria NS, Talbot L, Tecle R, Shannon M, Gerraty MIs R, Allen S, Boyle R, Fatchen N, Hendley N, Hyde A, Inal M, Kalubowilage P, Laverde M, Lawless K, McFadyen A, Peters K, Pugh C, Qin C, Robertson J, Smee S, Tomlinson R, Wang V, Williams F, Woolley D, Yawieriin R, Austin N, Pomfret S, Tinsley MIs M, Allport L, Ang C, Armitage L, Blundell E, Courtney A, Dela Costa M, Thapa TD, Diwakar P, Dulleh M, Francis J, Cic P, Gellie G, Gill C, James D, Lee S, Mai T, Majcher K, Mawson C, Newton G, Qiu N, Ragonton E, Roberts L, Saitamis H, Stanwell L, Ting L, Xu P, Yin L, Crosby Mi V, Broadhead K, Church J, Collins R, Everitt K, Fisher M, Hochmuth K, Jones N, Lieschke A, McCarthy E, McGlone C, Morey D, Neilson D, Spry S, Vile M, Grimley R, Rowley MIs D, Rosbergen I, Ahern E, Anderson L, Boreham J, Devin R, Doolan R, Dyke M, Griffiths L, Guest K, Hecita D, Kendal N, Koltermann J, Lacy M, Lebeter S, Lloyd D, Matthews M, McAuley C, Pollock A, Pyke M, Rogers T, Street S, Styles G, Tampiyappa A, Trinder J, Verral T, Walker K, White C, Beckwith T, Cormack MIs L, Arriagada J, Babenschneider C, Blacker D, Bennett S, Connor S, Cowmeadow J, Daniel N, Edmonds G, Faulkner M, Garcia-Vega M, Kruger K, Martial B, McGinley P, Mountford H, Riley V, Smith N, Stepan F, Tilley S, Whisson S, Groot Mi P, Bailey J, Ballinger K, Bell C, Camilleri B, Charnley C, Crabbe D, Crossland S, Edirimanna N, Fitzgerald C, Gibbins C, Gibbs J, Hirst K, Kennedy A, Klose E, McDowall K, Miller S, Morgan R, Noonan A, North M, Oliver M, Richards K, Russell T, Scott N, Shlanski A, Traynor A, Smith Mi S, Adams R, Banks C, Burke K, Hewat S, McKenna B, McKimmie M, Polmear L, Traumanis M, Whiteman S, Bramah V, Errey R, Halpin M, Molan V, Wheelwright D, Wilson N, Zhang MIs W, Bakshi M, Bracher S, Bryant M, Byrnes W, Denton T, DeVries N, Fay P, Galbraith P, Gallaher T, Haidar O, Holgate K, Hozack K, Jackson N, Kipps S, Lerner S, Markus R, Merheb R, Naismith C, Nolan G, Odelli R, Page K, Sangvatanakul P, Simpson T, van Vliet P, Walch K, Walker S, Yasue T, Auld Mi G, Baker R, Cousins K, Fairbrother M, Hutchinson K, Maclean M, Maher E, Mills D, Ohlback S, Sturm J, Tooth M, Watkins J, Cramb Mi J, Atkinson P, Conrad J, Fichera D, Follent S, Gilbert C, Herzig M, Kohler S, McCracken S, Nunan L, Roberts S, Shelley J, Varendorff S, Wills A, Moore A, Robertson MIs A, Britton J, Burgess A, Coates T, Croft J, Greening E, Holland J, O'Brien P, Strong R, Tighe Mi L, Bilston S, Black J, De Rivera K, Dwyer I, Gissane S, Heckenberg K, Jackson S, Maclagan A, O'Hare L, Patel H, Pearce J, Scanlan C, Seymour K, Symington M, Tyers A, Waite A, Wiesner K, Katalinic O, Spear MIs M, Brown P, Difuntorum E, Gilbert S, Henderson J, James D, Janssen H, Lane E, Lowndes S, Smith D, Thompson S, Weaver D, Weston S, Wright S, Cox S, Tse MIs C, Adrian J, Doughty M, Kok J, McGrath R, Morris T, Pickup A, Ray E, Richardson R, Sims M, Thompson C, Trinh K, Walton N, Whittaker F, Andersen Mi P, Burrows J, Dawson M, Griffiths D, Harris G, Kavalieros P, O'Brien B, Roberts K, Watkins J, Whyatt C, McRae A, Wavish MIs G, Anos F, Armstrong J, Au E, Barber A, Bates C, Bertulfo M, Boggs A, Burgess F, Cassels-Brown K, Chiu M, Dass S, Duff N, Farrell J, Foster W, Fuertez D, Gadhvi C, George S, Green A, Harvey-Fitzgerald L, Hau L, Hayward L, Holman D, Huggins K, Jacobs M, John A, Kaur H, Lagerstedt T, Lee J, Llenes R, Lyons L, Magandi S, Martin M, Mathew S, Mathew T, McKellar D, Moss E, Nand K, Nicol K, Peterson F, Prasad A, Quick K, Revell E, Roy S, Ryan J, Samadi N, Scrivener B, Slow J, Tharakan S, Torrens J, van Bysterveldt E, Villaluz C, Yang S, Katijjahbe M, Ai Sing G, Azlina A, Azmi M, Efri M, Fadilah A, Fathuddeen H, Haryani H, Hussien H, Izuani M, Man Z, Man Ying C, Mashitoh K, Noor Azah A, Norlinah M, Norliza I, Ravinder K, Rohaizah R, Rosnita K, Rozita A, Safwan J, Sahathevan R, Shahrul I, Sharifah S, Tan H, Wan Nafisah W, Yee Y, Zaharah M, Zunaidah A, Tan D, Ahmad M, Hameed MIs S, Bakari M, Britto J, Chen J, Choo S, Faizal M, Fong F, Hong S, Ja'afar J, Ke Z, Koh G, Lee C, Lee Y, Lim P, Lim G, Ninhadi Sh, Ong G, Pei TP, Penero V, Rahim N, Ratnagopal P, Saleh K, Seow H, Sim E, Tan C, Tay P, Teo I, Thilarajah S, Wong P, Wong W, Yeap S, Macleod Mi M, Anderson A, Armstrong K, Baird K, Balfour D, Boyd M, Cameron J, Carswell C, Clanachan C, Cuthill L, Devoy I, Forsyth S, Gavin J, Hughes M, Marr E, McAuley S, McCagherty E, McCallum K, McDonald N, McGhee C, McIntyre T, Noonan L, Smart A, Walshe R, Neal Mi D, Allison J, Ball G, Board S, Brunt H, Buckley C, Carroll C, Hayward D, Hutchinson T, Jones E, Keeling E, Marsh E, Mead N, Smith H, Vickers C, Williams-Yesson B, Wood D, Coyle J, Keeling MIs M, Ackroyd L, Brown C, Donnan K, Dyer N, Green H, Kilbride G, Nicholson C, Porteous M, Louw Mi S, Annamalai A, Barkat A, Crawford S, Fawcett M, Harvey D, Hogg V, Hughes A, Kemp J, Morrison J, Storey K, Thompson T, Furnace J, Macleod MIs M, Bell J, Bennett K, Bruce M, Clarke R, Cowie H, Gow H, Irvine J, Joyson A, MacDonald S, Macvicar A, Murphy N, Robertson J, Gordon C, Kwan J, Redpath L, Saunders MIs K, Bell J, Burrow R, Clarke C, Dickson C, Hann G, Heath M, Heath S, Hewett A, Humphrey R, Longland B, Orpen A, Ovington C, Page J, Rogers E, Toombs K, Howes R, Lacey A, Meakin MIs P, Ames D, Banerjee S, Beranova E, Berry S, Burke M, Cassama V, Collins K, Crow J, Dunne A, Gomez C, Hawkins A, Hellier K, Howard S, Kar A, Lambert E, Lee H, Mandri C, Moye J, Murtagh E, Pushpa-Rajah J, Richardson J, TSachs, Stilwell J, Tilley V, Wilding P, Wilson N, Feely E, Kirk MIs S, Cassidy P, Chalmers A, Duguid C, Hughes N, Hutton J, Lapsley K, Lee J, Murray A, Weir L, Whitelaw M, Barber M, Esson MIs D, Armit H, Devlin C, Duncan R, Forman C, Frame K, Hogg L, McLeod P, McWhinney R, Porter J, Purves M, Snowball L, Wroath Mi B, Ferson L, Gibson M, Gillespie S, Ignatius N, Kane T, Kwant J, Matthews M, McCallion C, McConville C, McDowell M, McNally C, Moore L, Murphy P, Nesbitt A, Newell J, Power M, Reid E, Robinson K, Charnley C, James MIs M, Bacon S, Booth N, Bowring A, Boxall L, Burt J, Cageao J, Green N, Gupwell K, Keenan S, Kingwell H, Kryszkowska M, Mortimore J, Peace B, Roughan C, Gunathilagan G, Sampson J, Thomas MIs G, Allen T, Dane G, Harris K, Hart S, Jones S, Reader M, Browne P, McGoldrick C, Mullan MIs D, Adair P, Armstrong J, Beggs E, Bell I, Edwards C, Gilligan L, Kelly C, Kennedy M, Kurian J, Leal L, McAtamney A, McKay E, Rogan E, Smyth M, Wiseman E, Vahidassr J, Price C, Riddell MIs V, Bendix E, Craig K, Davison R, Harrison A, Smith A, Green Mi V, Ashton K, Barkhuizen W, Daniel A, Dickinson C, Durdu H, Eastwood D, Goddard H, Hodkin R, Howard J, Jeffs C, Joyce S, Kelly C, Kerr G, Lanes J, Magnall B, McMahon M, Moody M, Patton S, Taylor R, Watson A, Mitchelson K, Mokoena MIs L, Aird L, Lakey R, Murdy J, Nelson K, Storey G, McGeown R, Tauro MIs S, Brady R, Holland D, Kinnaird M, Maltman L, Martin D, McCord K, McKenna S, Morgan C, Shannon C, Steele A, Wiggam I, Appleby S, Brotheridge S, Prescott MIs M, Bagot P, Baston D, Bennett C, Featherstone J, Hare C, McCluskey A, Wade S, Worton R, Hakim E, Herman J, Norman MIs T, Beale L, Buckley E, Byrne K, Gasior M, Robles B, Smallwood C, Stevens S, Thomas M, Williams V, Buck Mi K, Armstrong S, Brice V, Edwards A, Gething S, Griffiths A, Hills T, Howells D, Langdon S, Moseley S, Powell G, Reynolds G, Richard B, Scott E, White R, Zebedee J, Walters Mi M, Alexander J, Brand L, Colquhoun E, Hill A, Macartney D, MacDonald H, Manak B, Morgan H, Ritchie C, Hunter Mi H, Blair T, Duffy M, Graham J, Scott J, Vu T, Yorston P, Nair Mi A, Shakir I, Button C, Friend M, Greig J, Hairsine B, Wade S, Williamson S, Cloud Mi G, Adedoyin T, Dayal N, Gawned S, Ghatala R, Jeyaraj N, Kerin L, Montague L, Orefo C, O'Reilly J, Styles J, Trippier S, Watchurst C, Watson F, Hunt J, Latif MIs R, Barrett C, Cox J, Hammonds F, Quick K, Robinson K, Skinner A, Vernon C, Burgess S, Elder-Gracie MIs T, Browne C, Cameron W, Coleman V, Fulgencio C, Gibson L, Halliday P, Heaney D, Main L, McGavin K, Mead G, Proudfoot F, Redpath A, Rodger C, Scott S, Robinson K, Mason Mi K, Baxter L, Bryce A, Halkett M, Halliday J, McAllister A, McGuiness M, Munro M, Robb A, Thompson A, Tougher B, Weadon J, Young J, Douglas Mi C, McParland M, Boyle S, Byrne B, Comiskey L, Gilpin J, Gilpin S, Harris A, Harshaw S, Haughey J, McArdle F, McConnell L, McEneaney E, Millar M, Murphy M, Tilley J.

Abstract

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.

PMID:
26888985
PMCID:
PMC4898313
DOI:
10.1212/WNL.0000000000002459
[Indexed for MEDLINE]
Free PMC Article

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