Rehab After a Stroke – Don’t Waste a Minute
Sun, February 25, 2007 at 03:34AM In 1950 my father had a stroke, and his doctor insisted on 6 weeks’ bed rest as part of the treatment. His recovery was not very good. Now-a-days the bed rest would be regarded as totally wrong. But there is still a tendency to wait to begin rehabilitation exercise until the extent of the damage has been fully assessed.
Australian investigators have reported at the International Stroke Conference 2007 the results of their study of very early mobilization. Their study – A Very Early Rehabilitation Trial, or AVERT – enrolled 71 people admitted to hospital within 24 hours of first or recurrent stroke symptom onset. Over half of them had moderate to severe stroke.
Half the patients were randomized to receive immediate mobilization, with the emphasis on mobility training for 14 days, or until discharge, whichever was shorter. The other half received ‘standard care’. At the three-month point after their stoke, the overall death rate (15.5%) s was below the expected rate for comparable patients (23%); this finding offsets the fact that the death rate was higher in the early-mobilization group than in the standard care group. Those who died were older and more severely affected by their stroke.
The purpose of this pilot study was fulfilled – to demonstrate that very early rehabilitation can safely begin within 24 hours of a stroke. Preliminary findings regarding effectiveness suggest that early mobilization is feasible and safe. A full-scale AVERT study in over 2000 patients will begin shortly, in centers in Australia, North America, and Europe.
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Update: AVERT has now recruited about half their target of 2100 patients. Results to date are good - the death rate after 3 months is 5.9%, and the adverse effects of treatment 13.4%. These figures are better than historical numbers. However, almost half the stroke patients arriving at hospital are coming too late to be included in the study; participants must be enrolled within 24 hours of their first stroke symptoms.