Medicine (Western Health) - Research Publications

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Author: Bernhardt, Julie × Author: Wijeratne, Tissa ×

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    Very early mobilization following acute stroke: Controversies, the unknowns, and a way forward
    Bernhardt, J (WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2008-01)
    UNLABELLED: Evidence that organized stroke-unit care results in better outcome has led to positive changes in stroke service delivery around the world. It is well accepted that stroke rehabilitation should commence as early as possible for optimal recovery to be achieved. Exactly how early rehabilitation should start is controversial. Early mobilization (getting up out of bed within 24 h of stroke onset) is a wellestablished feature of acute stroke care in many Scandinavian hospitals. Elsewhere in the world, stroke protocols enforce bed rest for the first few days or foster long periods of bed rest after stroke. This paper aims to provide an overview of the topic of very early mobilization (VEM). It is divided into three sections: section 1 reviews the effects of bed rest and outlines arguments both for and against enforced bed rest after stroke; in section 2, VEM as a treatment for stroke and the limitations of existing literature in the field are described; and section 3 outlines the systematic approach that has been taken by our team of clinical researchers to the study the effect of VEM after stroke. CONCLUSION: VEM represents a simple, easy-to-deliver intervention, requiring little or no equipment. It is potentially deliverable to 85% of the acute stroke population and, if proven to be effective, may help reduce the significant personal and community burden of stroke. As current opinion about when mobilization should begin is divided, one way to move forward is through the conduct of a large high-quality clinical trial (such as A Very Early Rehabilitation Trial (AVERT)). Although some inroads have been made, further research in this field is clearly warranted.
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    Statistical analysis plan (SAP) for A Very Early Rehabilitation Trial (AVERT): an international trial to determine the efficacy and safety of commencing out of bed standing and walking training (very early mobilization) within 24 h of stroke onset vs. usual stroke unit care
    Bernhardt, J ; Churilov, L ; Dewey, H ; Lindley, RI ; Moodie, M ; Collier, J ; Langhorne, P ; Thrift, AG ; Donnan, G (SAGE PUBLICATIONS LTD, 2015-01)
    Currently, the acute stroke interventions for which there is evidence of efficacy are stroke unit care (a complex package), selected surgery , aspirin and thrombolysis. The stroke unit effect is powerful with a 20% relative reduction in mortality and similar reduction in disability. However the key components of this ‘black box’ are unknown. Starting out of bed sitting, standing and walking training early after stroke (early mobilization) have emerged as a component of care that may make an important contribution to the stroke unit care effect.