Early Mobilization After Stroke Is Not Associated With Cognitive Outcome

Toby B. Cumming, Julie Bernhardt, Danielle Lowe, Janice Collier, Helen Dewey, Peter Langhorne, Amanda G. Thrift, Ashleigh Green, Rajkumar Mohanraj, Sharon F. Kramer, Leonid Churilov, Thomas Linden, on behalf of the AVERT Trial Collaboration group

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background and Purpose- We aimed to determine whether early mobilization after stroke affects subsequent cognitive function. Methods- AVERT (A Very Early Rehabilitation Trial) was an international, 56-site, phase 3 randomized controlled trial, conducted from 2006 to 2015. Participants were included if they were aged 18+, presented within 24 hours of stroke, and satisfied physiological limits for blood pressure, heart rate, and temperature. Participants were randomized to receive either usual stroke unit care or very early and more frequent mobilization in addition to usual stroke unit care. The Montreal Cognitive Assessment, scored 0 to 30, was introduced as a 3-month outcome during 2008. Results- Of the 2104 patients included in AVERT, 317 were assessed before the Montreal Cognitive Assessment's introduction. Of the remaining 1787, 1189 (66.5%) had complete Montreal Cognitive Assessment data, 456 (25.5%) had partially or completely missing data, 136 (7.6%) had died, and 6 (0.3%) were lost to follow-up. In surviving participants with complete data, adjusting for age and stroke severity, total Montreal Cognitive Assessment score was no different in the intervention (n=595; median, 23; interquartile range, 19-26; mean, 21.9; SD, 5.9) and usual care (n=594; median, 23; interquartile range, 19-26; mean, 21.8; SD, 5.9) groups ( P=0.68). Conclusions- Exposure to earlier and more frequent mobilization in the acute stage of stroke does not influence cognitive outcome at 3 months. This stands in contrast to the primary outcome from AVERT (modified Rankin Scale), where the intervention group had less favorable outcomes than controls. Clinical Trial Registration- URL: https://www.anzctr.org.au . Unique identifier: ACTRN12606000185561.

Original languageEnglish
Pages (from-to)2147-2154
Number of pages8
JournalStroke
Volume49
Issue number9
DOIs
Publication statusPublished - 1 Sep 2018

Keywords

  • cognition
  • exercise
  • randomized controlled trial
  • rehabilitation
  • stroke

Cite this

Cumming, T. B., Bernhardt, J., Lowe, D., Collier, J., Dewey, H., Langhorne, P., ... on behalf of the AVERT Trial Collaboration group (2018). Early Mobilization After Stroke Is Not Associated With Cognitive Outcome. Stroke, 49(9), 2147-2154. https://doi.org/10.1161/STROKEAHA.118.022217
Cumming, Toby B. ; Bernhardt, Julie ; Lowe, Danielle ; Collier, Janice ; Dewey, Helen ; Langhorne, Peter ; Thrift, Amanda G. ; Green, Ashleigh ; Mohanraj, Rajkumar ; Kramer, Sharon F. ; Churilov, Leonid ; Linden, Thomas ; on behalf of the AVERT Trial Collaboration group. / Early Mobilization After Stroke Is Not Associated With Cognitive Outcome. In: Stroke. 2018 ; Vol. 49, No. 9. pp. 2147-2154.
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title = "Early Mobilization After Stroke Is Not Associated With Cognitive Outcome",
abstract = "Background and Purpose- We aimed to determine whether early mobilization after stroke affects subsequent cognitive function. Methods- AVERT (A Very Early Rehabilitation Trial) was an international, 56-site, phase 3 randomized controlled trial, conducted from 2006 to 2015. Participants were included if they were aged 18+, presented within 24 hours of stroke, and satisfied physiological limits for blood pressure, heart rate, and temperature. Participants were randomized to receive either usual stroke unit care or very early and more frequent mobilization in addition to usual stroke unit care. The Montreal Cognitive Assessment, scored 0 to 30, was introduced as a 3-month outcome during 2008. Results- Of the 2104 patients included in AVERT, 317 were assessed before the Montreal Cognitive Assessment's introduction. Of the remaining 1787, 1189 (66.5{\%}) had complete Montreal Cognitive Assessment data, 456 (25.5{\%}) had partially or completely missing data, 136 (7.6{\%}) had died, and 6 (0.3{\%}) were lost to follow-up. In surviving participants with complete data, adjusting for age and stroke severity, total Montreal Cognitive Assessment score was no different in the intervention (n=595; median, 23; interquartile range, 19-26; mean, 21.9; SD, 5.9) and usual care (n=594; median, 23; interquartile range, 19-26; mean, 21.8; SD, 5.9) groups ( P=0.68). Conclusions- Exposure to earlier and more frequent mobilization in the acute stage of stroke does not influence cognitive outcome at 3 months. This stands in contrast to the primary outcome from AVERT (modified Rankin Scale), where the intervention group had less favorable outcomes than controls. Clinical Trial Registration- URL: https://www.anzctr.org.au . Unique identifier: ACTRN12606000185561.",
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Cumming, TB, Bernhardt, J, Lowe, D, Collier, J, Dewey, H, Langhorne, P, Thrift, AG, Green, A, Mohanraj, R, Kramer, SF, Churilov, L, Linden, T & on behalf of the AVERT Trial Collaboration group 2018, 'Early Mobilization After Stroke Is Not Associated With Cognitive Outcome' Stroke, vol. 49, no. 9, pp. 2147-2154. https://doi.org/10.1161/STROKEAHA.118.022217

Early Mobilization After Stroke Is Not Associated With Cognitive Outcome. / Cumming, Toby B.; Bernhardt, Julie; Lowe, Danielle; Collier, Janice; Dewey, Helen; Langhorne, Peter; Thrift, Amanda G.; Green, Ashleigh; Mohanraj, Rajkumar; Kramer, Sharon F.; Churilov, Leonid; Linden, Thomas; on behalf of the AVERT Trial Collaboration group.

In: Stroke, Vol. 49, No. 9, 01.09.2018, p. 2147-2154.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Early Mobilization After Stroke Is Not Associated With Cognitive Outcome

AU - Cumming, Toby B.

AU - Bernhardt, Julie

AU - Lowe, Danielle

AU - Collier, Janice

AU - Dewey, Helen

AU - Langhorne, Peter

AU - Thrift, Amanda G.

AU - Green, Ashleigh

AU - Mohanraj, Rajkumar

AU - Kramer, Sharon F.

AU - Churilov, Leonid

AU - Linden, Thomas

AU - on behalf of the AVERT Trial Collaboration group

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background and Purpose- We aimed to determine whether early mobilization after stroke affects subsequent cognitive function. Methods- AVERT (A Very Early Rehabilitation Trial) was an international, 56-site, phase 3 randomized controlled trial, conducted from 2006 to 2015. Participants were included if they were aged 18+, presented within 24 hours of stroke, and satisfied physiological limits for blood pressure, heart rate, and temperature. Participants were randomized to receive either usual stroke unit care or very early and more frequent mobilization in addition to usual stroke unit care. The Montreal Cognitive Assessment, scored 0 to 30, was introduced as a 3-month outcome during 2008. Results- Of the 2104 patients included in AVERT, 317 were assessed before the Montreal Cognitive Assessment's introduction. Of the remaining 1787, 1189 (66.5%) had complete Montreal Cognitive Assessment data, 456 (25.5%) had partially or completely missing data, 136 (7.6%) had died, and 6 (0.3%) were lost to follow-up. In surviving participants with complete data, adjusting for age and stroke severity, total Montreal Cognitive Assessment score was no different in the intervention (n=595; median, 23; interquartile range, 19-26; mean, 21.9; SD, 5.9) and usual care (n=594; median, 23; interquartile range, 19-26; mean, 21.8; SD, 5.9) groups ( P=0.68). Conclusions- Exposure to earlier and more frequent mobilization in the acute stage of stroke does not influence cognitive outcome at 3 months. This stands in contrast to the primary outcome from AVERT (modified Rankin Scale), where the intervention group had less favorable outcomes than controls. Clinical Trial Registration- URL: https://www.anzctr.org.au . Unique identifier: ACTRN12606000185561.

AB - Background and Purpose- We aimed to determine whether early mobilization after stroke affects subsequent cognitive function. Methods- AVERT (A Very Early Rehabilitation Trial) was an international, 56-site, phase 3 randomized controlled trial, conducted from 2006 to 2015. Participants were included if they were aged 18+, presented within 24 hours of stroke, and satisfied physiological limits for blood pressure, heart rate, and temperature. Participants were randomized to receive either usual stroke unit care or very early and more frequent mobilization in addition to usual stroke unit care. The Montreal Cognitive Assessment, scored 0 to 30, was introduced as a 3-month outcome during 2008. Results- Of the 2104 patients included in AVERT, 317 were assessed before the Montreal Cognitive Assessment's introduction. Of the remaining 1787, 1189 (66.5%) had complete Montreal Cognitive Assessment data, 456 (25.5%) had partially or completely missing data, 136 (7.6%) had died, and 6 (0.3%) were lost to follow-up. In surviving participants with complete data, adjusting for age and stroke severity, total Montreal Cognitive Assessment score was no different in the intervention (n=595; median, 23; interquartile range, 19-26; mean, 21.9; SD, 5.9) and usual care (n=594; median, 23; interquartile range, 19-26; mean, 21.8; SD, 5.9) groups ( P=0.68). Conclusions- Exposure to earlier and more frequent mobilization in the acute stage of stroke does not influence cognitive outcome at 3 months. This stands in contrast to the primary outcome from AVERT (modified Rankin Scale), where the intervention group had less favorable outcomes than controls. Clinical Trial Registration- URL: https://www.anzctr.org.au . Unique identifier: ACTRN12606000185561.

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KW - exercise

KW - randomized controlled trial

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KW - stroke

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Cumming TB, Bernhardt J, Lowe D, Collier J, Dewey H, Langhorne P et al. Early Mobilization After Stroke Is Not Associated With Cognitive Outcome. Stroke. 2018 Sep 1;49(9):2147-2154. https://doi.org/10.1161/STROKEAHA.118.022217