http://www.medscape.com/viewarticle/843768
A very early and more intensive rehabilitation program was associated with a reduced likelihood of achieving a favorable outcome at 3 months vs usual care in the first large-scale randomized trial of rehabilitation therapy in patients with acute stroke.
The AVERT study results were presented by Professor Julie Bernhardt, PhD, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia, at the inaugural European Stroke Organisation (ESO) Conference 2015. They were also simultaneously published online in The Lancet.
"Our data show that an early, lower-dose out-of-bed activity regimen is preferable to very early, frequent, higher-dose intervention," Professor Bernhardt concluded.
"This was an unexpected and intriguing result," she added. "But it tells us something very important. Earlier intensive rehabilitation was significantly worse than usual care. We have to listen to that."
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To Medscape Medical News she commented that the study had only just finished and it was too premature to issue strong recommendations.
"It is very early days," she said. "We will be coming up with clear recommendations for clinical practice, but for now we can say that earlier high-dose rehabilitation is not better than usual care, which in this study was still early but not quite as early or intensive as the more aggressive arm."
"However, the challenge is not as simple as just recommending usual care, because usual care is complex and this study was also delivered early and varied from center to center, and we had 56 centers in 5 countries. We have to unpack this so we can give clinicians guidance about their practice and this will be the next step."
She added: "We do know from previous studies that patients in stroke units who receive earlier rehabilitation than patients on general medical wards have better outcomes. So our message is not that patients should stay in bed for days."
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