Early mobilization and quality of life after stroke: findings from AVERT

Cumming, T. B. et al. (2019) Early mobilization and quality of life after stroke: findings from AVERT. Neurology, 93(7), e717-e728. (doi: 10.1212/WNL.0000000000007937) (PMID:31350296)

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Abstract

Objective: To determine whether early and more frequent mobilization after stroke affects health-related quality of life. Methods: A Very Early Rehabilitation Trial (AVERT) was an international, multicenter (56 sites), phase 3 randomized controlled trial, spanning 2006–2015. People were included if they were aged ≥18 years, presented within 24 hours of a first or recurrent stroke (ischemic or hemorrhagic), and satisfied preordained physiologic criteria. Participants were randomized to usual care alone or very early and more frequent mobilization in addition to usual care. Quality of life at 12 months was a prespecified secondary outcome, evaluated using the Assessment of Quality of Life 4D (AQoL-4D). This utility-weighted scale has scores ranging from −0.04 (worse than death) to 1 (perfect health). Participants who died were assigned an AQoL-4D score of 0. Results: No significant difference in quality of life at 12 months between intervention (median 0.47, interquartile range [IQR] 0.07–0.81) and usual care (median 0.49, IQR 0.08–0.81) groups was identified (p = 0.86), nor were there any group differences across the 4 AQoL-4D domains. The same lack of group difference in quality of life was observed at 3 months. When cohort data were analyzed (both groups together), quality of life was strongly associated with acute length of stay, independence in activities of daily living, cognitive function, depressive symptoms, and anxiety symptoms (all p < 0.001). Quality of life in AVERT participants was substantially lower than population norms, and the gap increased with age. Conclusions: Earlier and more frequent mobilization after stroke did not influence quality of life.

Item Type:Articles
Additional Information:The trial was initially supported by the National Health and Medical Research Council (NHMRC) of Australia (grants 386201, 1041401). Additional funding was received from Chest Heart and Stroke Scotland (Res08/A114), Northern Ireland Chest Heart and Stroke, Singapore Health (SHF/ FG401P/2008), the UK Stroke Association (TSA2009/09), and the UK National Institute of Health Research (HTA Project 12/01/16). NHMRC fellowship funding was provided to A.G.T. (1042600), H.D. (336102), and J.B. (1058635). J.B. also received fellowship funding from the Australia Research Council (0991086) and the National Heart Foundation.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Langhorne, Professor Peter
Authors: Cumming, T. B., Churilov, L., Collier, J., Donnan, G., Ellery, F., Dewey, H., Langhorne, P., Lindley, R. I., Moodie, M., Thrift, A. G., and Bernhardt, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Neurology
Publisher:American Academy of Neurology
ISSN:0028-3878
ISSN (Online):1526-632X
Published Online:26 July 2019
Copyright Holders:Copyright © 2019 American Academy of Neurology
First Published:First published in Neurology 93(7):e717-e728
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
190006A multi-centre randomised controlled trial of very early mobilisation after stroke (AVERT) in ScotlandPeter LanghorneChest Heart and Stroke Scotland (CHSS)08/A114Institute of Cardiovascular & Medical Sciences