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

在澳大利亚，中风占所有慢性残疾的25%。随着人口老龄化，中风相关残疾的个人和社区负担在未来20年可能会显著增加。如果没有有效的预防和治疗策略，与中风有关的残疾及其相关费用将会增加。要使治疗对死亡或依赖产生任何重大影响，这些治疗必须广泛可及、具有成本效益、适当、安全和对绝大多数患者有效。来自挪威的初步证据表明，与接受普通病房护理的患者相比，在中风后24小时内开始活动（即坐床、站立和行走）的患者更有可能出院回家（而不需要长期养老院护理），住院时间更短，结果更好。这种干预措施简单，比许多其他急性干预措施适用范围更广，但需要进行试验。我们将开展首个卒中后早期活动的随机对照试验，以确定干预的成本和收益。患者将被随机分配接受标准治疗或标准治疗，以及非常早期和频繁的动员。在脑卒中后3个月，我们将确定每组患者死亡和残疾的人数，以确定干预对结果的影响。我们还将确定护理费用和长期生活质量。试验设计可以与其他标准干预措施进行比较，以改善卒中结果。我们已经招募了两个地点，并将46名患者随机分配到试点研究中。没有提出安全或可行性方面的担忧。如果结果是积极的，这项研究有可能导致临床实践的重大变化，这可能有助于减轻个人和更广泛社区的中风负担。

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.