Improving outcome after stroke: A large, multicentre, randomised controlled trial of very early mobilisation (AVERT)

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In Australia, stroke accounts for 25% of all chronic disability. The personal and community burden of stroke-related disability is likely to increase considerably over the next 20 years, as the population ages. Without effective prevention and treatment strategies, stroke-related disability and its associated costs will increase. For treatments to have any major impact on death or dependency, they must be widely accessible, cost-effective, appropriate, safe and effective in the vast majority of patients. There is preliminary evidence from Norway that patients who start mobilising (i.e. sitting out of bed, standing and walking) within 24 hours of stroke are more likely to be discharged home (rather than require long term nursing home care), have a shorter stay in hospital, and improved outcome compared to patients who receive general medical ward care. This intervention is simple and more widely applicable than many other acute interventions, but it requires testing. We will conduct the first randomised controlled trial of very early mobilisation after stroke to determine the cost and benefits of the intervention. Patients will be randomised to receive either standard care or standard care in addition to very early and frequent mobilisation. At 3 months post stroke, we will identify the number of patients dead and disabled in each group to determine the effect of intervention on outcome. We will also determine care costs and quality of life in the longer term. The trial design enables comparisons to other standard interventions to improve stroke outcome to be made. We have already recruited two sites and randomised 46 patients to the pilot study. No safety or feasibility concerns have been raised. If positive, this study has the potential to lead to significant changes in clinical practice that may serve to reduce the burden of stroke to both individuals and the broader community.