A Very Early Rehabilitation Trial (AVERT)
A Very Early Rehabilitation Trial (AVERT)
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DOI：
10.1111/j.1747-4949.2006.00044.x
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发表时间：
2006-08-01
影响因子：
6.7
通讯作者：
Donnan, Geoffrey
中科院分区：
文献类型：
--
作者：
Bernhardt, Julie;Dewey, Helen;Donnan, Geoffrey
在发达国家，如果活到85岁，四分之一的男性和五分之一的女性可能会患中风（1）。中风导致过早死亡和残疾，然而，与冠心病和癌症相比，其主要负担是慢性残疾而不是死亡（2）。我们知道，在卒中监护室（SCU）环境中接受有组织的多学科护理的卒中患者死亡率和依赖性降低（3）。然而，它是不确定的SCU管理战略的组成部分负责改善的结果。卒中后尽早开始活动的益处的最强有力证据来自挪威随机试验SCU与普通内科病房护理的事后分析，并使用6周出院作为替代结局指标（4）。在ICU接受治疗（并接受极早期动员，以下称为VEM）的患者死亡或残疾的可能性降低了64%。在区分卒中单元与一般医疗护理的因素中，VEM被认为是改善结局以及更好的血压控制的最强预测因子（5）。该分析表明，VEM可能占SCU效益的78%。中风后尽早开始活动（即下床坐、站立和行走），并在出院前频繁进行活动，可能会降低中风患者的残疾程度，减少需要护理的患者数量（5）。尽管是初步的，但这些研究的证据已经促使澳大利亚（6）和国际（7）将早期动员纳入急性卒中护理最佳实践指南。由于只有低水平的证据支持这些指南，因此显然需要进行早期动员的干预性试验，以确定卒中患者的早期动员是否安全，改善结局，并且具有成本效益。为了做到这一点，我们已经开始了一个非常早期康复试验（AVERT）。我们的目的是确定这种早期干预的有效性和成本效益。
In the developed world, one in four men and one in five women can expect to suffer a stroke if they live to 85 years (1). Stroke results in both premature death and disability however, in contrast to coronary heart disease and cancer, its major burden is chronic disability rather than death (2). We know that stroke patients who have received organised multidisciplinary care in a Stroke Care Unit (SCU) environment have reduced mortality and dependency (3). However, it is uncertain which components of the SCU management strategies are responsible for improved outcomes. The strongest evidence for the benefit of starting mobilisation as early as possible after stroke comes from a post hoc analysis of the Norwegian randomized trial of SCU vs. general medical ward care and using discharge at six weeks as a surrogate outcome measure (4). Patients managed in the SCU (and receiving very early mobilisation, hereafter known as VEM) were 64% less likely to be dead or disabled. Of the factors that distinguished stroke unit from general medical care, VEM was found to be the strongest predictor of improved outcome together with better blood pressure control (5). This analysis indicated that VEM may account for as much as 78% of the SCU benefit. Starting mobilisation (ie sitting out of bed, standing and walking) very early after stroke and continuing it at frequent intervals until discharge, may reduce the level of disability experienced by stroke patients and reduce the number of patients requiring nursing home care (5). Although preliminary, the evidence from these studies has prompted the inclusion of early mobilisation in acute stroke care best practice guidelines both in Australia (6) and internationally (7). As there is only a low level of evidence to support these guidelines there is an obvious need to conduct an interventional trial of early mobilisation to determine whether early mobilisation of stroke patients is safe, improves outcomes and is cost effective. In order to do this we have commenced A Very Early Rehabilitation Trial (AVERT). Our is to determine the efficacy and cost effectiveness of this early intervention.