Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT)
نویسندگان
- Julie Bernhardt
- Leonid Churilov
- Fiona Ellery
- Janice Collier
- Jan Chamberlain
- Peter Langhorne
- Richard I. Lindley
- Marj Moodie
- Helen Dewey
- Amanda G. Thrift
- Geoff Donnan
- Geoffrey Donnan
- Richard Lindley
- Marjory Moodie
- Brooke Parsons
- Amanda Thrift
- Main Investigators MIs
- Bent Indredavik
- Torunn Askim
- Phillip Bath
- Christopher Bladin
- Christopher Reid
- Stephen Read
- Cathy Said
- Sandy Middleton
- Judith Frayne
- Velandai Srikanth
- Australia: Julie Bernhardt
- Robert Carter
- Olivia Wu
- Matthew Walters Claire Ritchie
- Lorraine Smith
- Anne Ashburn
- Helen Rodgers
- Helen Rogers
- Sheila Lennon
- Michael Power
- Shahul Hameed
- Ratnagopal Pavanni
- Peter Lim
- Dawn Tan
- Tim Brewer
- Nick Haritos
- Edwin Leong
- Cecilia Li
- Caesar NayWin
- Marcus Nicol
- Liudmyla Olenka
- Li Chun Quang
- Silvia Hope
- Lauren Sheppard
- Kiusiang Tay- Teo
- Toby Cumming
- Thomas Linden
- Karen Borschmann
- Teresa Occhiodoro
- Helen Palfreeman
- Tara Purvis
- Bernadette Sirgo
- Nick Tiliacos
- John Van Holsteyn
- Henry Zhao
- Beverly Armstrong
- Louise Craig
- Fiona Graham
- Lynn Legg
- Rosemary Morrison
- Heather Moorhead
- Lorraine O’Donohue
- Susan Rogers
- Myra Smith
- Denise Forshaw
- Jane Fitzgerald
- E Hibbert
- R Melling
- S Petrolo
- T Purvis
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- M Pathirage
- A Paton
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- P Cic
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- C Gill
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- G Newton
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- L Roberts
- H Saitamis
- L Stanwell
- L Ting
- P Xu
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- D Lloyd
- M Matthews
- C McAuley
- A Pollock
- M Pyke
- T Rogers
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- G Styles
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- J Trinder
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- K Walker
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- J Arriagada
- C Babenschneider
- D Blacker
- S Bennett
- S Connor
- J Cowmeadow
- N Daniel
- G Edmonds
- M Faulkner
- M Garcia-Vega
- K Kruger
- B Martial
- P McGinley
- H Mountford
- V Riley
- N Smith
- F Stepan
- S Tilley
- S Whisson
- P Groot MI
- J Bailey
- K Ballinger
- C Bell
- B Camilleri
- C Charnley
- D Crabbe
- S Crossland
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- C Gibbins
- J Gibbs
- K Hirst
- A Kennedy
- E Klose
- K McDowall
- S Miller
- R Morgan
- A Noonan
- M North
- M Oliver
- K Richards
- T Russell
- N Scott
- A Shlanski
- A Traynor
- S Smith MI
- R Adams
چکیده
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.
منابع مشابه
Early mobilization after stroke: an example of an individual patient data meta-analysis of a complex intervention.
BACKGROUND AND PURPOSE Very early mobilization (VEM) is a distinctive characteristic of care in some stroke units; however, evidence of the effectiveness of this approach is limited. To date, only 2 phase II trials have compared VEM with standard care: A Very Early Rehabilitation Trial (AVERT) in Australia and the recently completed Very Early Rehabilitation or Intensive Telemetry after Stroke ...
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عنوان ژورنال:
دوره 86 شماره
صفحات -
تاریخ انتشار 2016