A Very Early Rehabilitation Trial (AVERT) was a Phase 3 randomized trial with over 2100 subjects post stroke that had unexpected results with better outcomes for usual care than those receiving very early mobilization. This review of published stroke clinical practice guidelines highlights that recommendations for mobilization have changed after publication of AVERT but also that developers have struggled to provide recommendations for appropriate dose, duration and intensity of mobilization in the acute post stroke period with available analyses from AVERT and other literature. This review highlights the priority research questions about early rehabilitation post stroke that need to be addressed through future large scale randomized controlled trials.
BernhardtJLanghornePLindleyRIet al.AVERT Trial Collaboration group. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet2015; 386: 46–55.
2.
TianS1ZhangYTianSet al.Early exercise training improves ischemic outcome in rats by cerebral hemodynamics. Brain Res2013; 1533: 114–121.
3.
MatsudaF1SakakimaHYoshidaY. The effects of early exercise on brain damage and recovery after focal cerebral infarction in rats. Acta Physiol (Oxf)2011; 201: 275–287.
4.
ParkJW1BangMSKwonBSet al.Early treadmill training promotes motor function after hemorrhagic stroke in rats. Neurosci Lett2010; 471: 104–108.
5.
AskimTBernhardtJSalevesenOIndredavikB. Physical activity early after stroke and its association to functional outcome 3 months later. J Stroke Cerebrovasc Dis2014; 23: e305–e312.
6.
IndredavikBBakkeFSlørdahlSARoksethRHâheimLL. Treatment in a combined acute and rehabilitation stroke unit which aspects are most important?Stroke1999; 30: 917–923.
7.
BernhardtJDeweyHThriftACollierJDonnanG. A Very Early Rehabilitation Trial for stroke (AVERT): phase II safety and feasibility. Stroke2008; 39: 390–396.
8.
Tay-TeoKMoodieMBernhardtJet al.Economic evaluation alongside a phase II, multi-centre, randomised controlled trial of very early rehabilitation after stroke). Cerebrovasc Dis2008; 26: 475–481.
9.
LynchEHillierSCadilhacD. When should physical rehabilitation commence after stroke: a systematic review. Int J Stroke2014; 9: 468–478.
10.
BernhardtJChurilovLElleryFet al.Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT). Neurology2016; 86: 2138–2145.
11.
Anderson C, et al. Head position in stroke trial: An international cluster cross-over randomized trial late breaking abstract (LB1) presentation. In: International stroke conference, Houston, 22 February 2017, http://www.abstractsonline.com/pp8/#!/4172/presentation/13132 (2017, accessed 4 August 2017).
Management of patients with stroke: Rehabilitation, prevention and management of complications, and discharge planning Scottish Intercollegiate Guidelines Network 2011, http://www.sign.ac.uk/pdf/qrg118.pdf (2011, accessed 27 February 2017).
15.
European Stroke Organisation Recommendations to Establish a Stroke Unit and Stroke Center. Ringelstein EB, Chamorro A, Kaste M et al for the ESO Stroke Unit Certification Committee. Stroke2013; 44: 828–840.
16.
Lindsay MP, Norrving B, Furie KL, et al. On Behalf of the Global Stroke Quality and Guidelines Advisory Committee, the Global Stroke Guidelines Working Group, and the Global Stroke Quality Working Group. World Stroke organization - Clinical practice guideline, http://www.world-stroke.org (2016, accessed 25 February 2017).
17.
LindsayPFurieKLDavisSMet al.World Stroke Organization global stroke services guidelines and action plan. Int J Stroke2014; 9(Issue Supplement A100): 4–13.
18.
MiddletonSGrimleyRAlexandrovA. Triage, treatment, and transfer evidence-based clinical practice recommendations and models of nursing care for the first 72 hours of admission to hospital for acute stroke. Stroke2015; 46: e18–e25.
19.
HebertDLindsayMPMcIntyreAet al.Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015. Int J Stroke2016; 11: 459–484.
20.
JauchECSaverJLAdamsHPet al.on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, and Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke2013; 44: 870–947.
