Early mobilization and quality of life after stroke

Findings from AVERT

Toby B. Cumming, Leonid Churilov, Janice Collier, Geoffrey Donnan, Fiona Ellery, Helen Dewey, Peter Langhorne, Richard I. Lindley, Marj Moodie, Amanda G. Thrift, Julie Bernhardt, on behalf of the AVERT Trial Collaboration group

Research output: Contribution to journalArticleResearchpeer-review

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. CLINICAL TRIAL REGISTRATION: anzctr.org.au; ACTRN12606000185561 CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for people with stroke, earlier and more frequent mobilization did not influence quality of life over the subsequent year.

Original languageEnglish
Pages (from-to)e717-e728
Number of pages12
JournalNeurology
Volume93
Issue number7
DOIs
Publication statusPublished - 13 Aug 2019

Cite this

Cumming, T. B., Churilov, L., Collier, J., Donnan, G., Ellery, F., Dewey, H., ... on behalf of the AVERT Trial Collaboration group (2019). Early mobilization and quality of life after stroke: Findings from AVERT. Neurology, 93(7), e717-e728. https://doi.org/10.1212/WNL.0000000000007937
Cumming, Toby B. ; Churilov, Leonid ; Collier, Janice ; Donnan, Geoffrey ; Ellery, Fiona ; Dewey, Helen ; Langhorne, Peter ; Lindley, Richard I. ; Moodie, Marj ; Thrift, Amanda G. ; Bernhardt, Julie ; on behalf of the AVERT Trial Collaboration group. / Early mobilization and quality of life after stroke : Findings from AVERT. In: Neurology. 2019 ; Vol. 93, No. 7. pp. e717-e728.
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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. CLINICAL TRIAL REGISTRATION: anzctr.org.au; ACTRN12606000185561 CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for people with stroke, earlier and more frequent mobilization did not influence quality of life over the subsequent year.",
author = "Cumming, {Toby B.} and Leonid Churilov and Janice Collier and Geoffrey Donnan and Fiona Ellery and Helen Dewey and Peter Langhorne and Lindley, {Richard I.} and Marj Moodie and Thrift, {Amanda G.} and Julie Bernhardt and {on behalf of the AVERT Trial Collaboration group}",
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Cumming, TB, Churilov, L, Collier, J, Donnan, G, Ellery, F, Dewey, H, Langhorne, P, Lindley, RI, Moodie, M, Thrift, AG, Bernhardt, J & on behalf of the AVERT Trial Collaboration group 2019, 'Early mobilization and quality of life after stroke: Findings from AVERT', Neurology, vol. 93, no. 7, pp. e717-e728. https://doi.org/10.1212/WNL.0000000000007937

Early mobilization and quality of life after stroke : Findings from AVERT. / Cumming, Toby B.; Churilov, Leonid; Collier, Janice; Donnan, Geoffrey; Ellery, Fiona; Dewey, Helen; Langhorne, Peter; Lindley, Richard I.; Moodie, Marj; Thrift, Amanda G.; Bernhardt, Julie; on behalf of the AVERT Trial Collaboration group.

In: Neurology, Vol. 93, No. 7, 13.08.2019, p. e717-e728.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Early mobilization and quality of life after stroke

T2 - Findings from AVERT

AU - Cumming, Toby B.

AU - Churilov, Leonid

AU - Collier, Janice

AU - Donnan, Geoffrey

AU - Ellery, Fiona

AU - Dewey, Helen

AU - Langhorne, Peter

AU - Lindley, Richard I.

AU - Moodie, Marj

AU - Thrift, Amanda G.

AU - Bernhardt, Julie

AU - on behalf of the AVERT Trial Collaboration group

PY - 2019/8/13

Y1 - 2019/8/13

N2 - 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. CLINICAL TRIAL REGISTRATION: anzctr.org.au; ACTRN12606000185561 CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for people with stroke, earlier and more frequent mobilization did not influence quality of life over the subsequent year.

AB - 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. CLINICAL TRIAL REGISTRATION: anzctr.org.au; ACTRN12606000185561 CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for people with stroke, earlier and more frequent mobilization did not influence quality of life over the subsequent year.

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Cumming TB, Churilov L, Collier J, Donnan G, Ellery F, Dewey H et al. Early mobilization and quality of life after stroke: Findings from AVERT. Neurology. 2019 Aug 13;93(7):e717-e728. https://doi.org/10.1212/WNL.0000000000007937