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Research looks at early rehabilitation care for stroke patients

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Research looks at early rehabilitation care for stroke patients


Western Health has collaborated with other metropolitan Melbourne stroke units to evaluate the safety and feasibility of early rehabilitation protocol for stroke patients. 

The results for the Acute Very Early Rehabilitation Trial (AVERT) were recently released at the European Stroke Conference in Glasgow.

"Stroke is one of the leading causes of adult disability globally," Western Health's Director of the Stroke Unit & Neuroscience Research Unit, Professor Tissa Wijeratne said.

"Early mobilisation after stroke, such as sitting out of bed, standing and walking, is thought to contribute  to the effect of stroke unit care.

"Early mobilisation after stroke is recommended in many national and international guidelines, however, there is no clear definition on 'early mobilisation' or evidence to support this.

"Before AVERT, evidence for early mobilisation after stroke came from three small studies including 159 patients," Prof Wijeratne added.

Between 18 July 2006 and October 16 2014, the AVERT collaboration group went on to study 2104 patients, with 1054 patients  receiving very early mobilisation and 1050 patients receiving usual care. Of the 1054 patients to receive early mobilisation, 965 patients, or 92%, were mobilised within 24 hours of stroke onset compared with 623 (59%) of patients in the usual care group.

The key findings of AVERT showed that early mobilisation group, mobilised 4.8 hours earlier than the control at a higher frequency with 21 more minutes per day of mobilisation compared to the usual care group,  performed worse at three months disability compared to the usual care group. There were no differences in mortality or length of stay between groups.

Professor Wijeratne and Stroke Nurse Practitioner Elizabeth Mackey led the Western Health research group with contributions from other stroke nurses, allied health researchers and neurology registrars.

"Western Health had 37 patients take part in the trial and we were very proud to take part in a landmark neuro-rehabilitation trial in acute stroke care," Prof Wijeratne said.

Prof Wijeratne was quick to point out that there are still lot of unanswered questions, such as -

  • When should we start rehabilitation after acute stroke?
  • What should acute stroke rehabilitation consist of?
  • Why do some patients respond better to more conservative approach while others do better with more therapy?
  • Dose enriched rehab environment offer better out come after stroke?
  • Would improved understanding of molecular mechanisms induced by early physical activity on stroke affected brain tissue hold some of the secrets behind early rehabilitation?​

"Our research group will continue to collaborate with La Trobe University, University of Melbourne, Monash University and Florey Institute to find answers to these questions in the coming months and years," Prof Wijeratne said.