Medicine (Austin & Northern Health) - Research Publications

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Author: Bernhardt, Julie × Author: Cadilhac, Dominique × End date: 2022 × Start date: 2020 × Type: Journal Article ×

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    Acute Hospital Admission for Stroke Is Characterised by Inactivity
    Sheedy, R ; Kramer, SF ; Johnson, L ; Shields, N ; Churilov, L ; Cadilhac, DA ; Bernhardt, J (HINDAWI LTD, 2020-02-11)
    Background. Measuring physical activity behaviours of stroke survivors in the inpatient setting is challenging. Authors of observational studies of early poststroke report that stroke survivors are “inactive and alone”. Using activity monitoring devices may help refine clinical practice and inform therapeutic activity targets. Aim. To measure the physical activity behaviour of stroke survivors during acute inpatient hospitalisation. We hypothesized that greater levels of inactivity would be positively associated with stroke severity and age. Method. Using a cross-sectional study design, consecutive stroke patients admitted to an acute stroke unit (Geelong, Australia) and recruited within 48 hours of admission had their physical activity recorded using an ActivPAL™ accelerometer device over a minimum of 3 days. Activity was categorised as time spent inactive (lying or sitting), standing, or stepping. The number of steps per day was recorded. Demographic and ActivPal™ data are described. Results. Seventy-eight stroke survivors were recruited of whom 54 had complete data for 3 days, all starting within 2 days poststroke. Of the 54 participants, 32 had a mild stroke, 17 moderate, and five severe stroke. Nine were able to walk independently at admission. The median age was 82.5 years (interquartile range (IQR) 74-86), 26 were female. On average, during their inpatient stay, participants spent a median of 98% of their admission inactive. A median of 18 minutes per day was spent standing and less than a minute per day was spent walking amounting to a median of 169 steps taken per day. Conclusion. The ActivePal™ device was feasible to use in an acute stroke setting. We observed high levels of inactivity in the first days post-stroke, highlighting the ongoing challenge of promoting activity in the acute stroke period. To our knowledge, this is the largest study to provide objective data on time spent upright, walking, and sedentary using accelerometer data in an acute stroke setting.
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    A randomized control trial of intensive aphasia therapy after acute stroke: The Very Early Rehabilitation for SpEech (VERSE) study
    Godecke, E ; Armstrong, E ; Rai, T ; Ciccone, N ; Rose, ML ; Middleton, S ; Whitworth, A ; Holland, A ; Ellery, F ; Hankey, GJ ; Cadilhac, DA ; Bernhardt, J (SAGE PUBLICATIONS LTD, 2021-07)
    BACKGROUND: Effectiveness of early intensive aphasia rehabilitation after stroke is unknown. The Very Early Rehabilitation for SpEech trial (VERSE) aimed to determine whether intensive aphasia therapy, beginning within 14 days after stroke, improved communication recovery compared to usual care. METHODS: Prospective, randomized, single-blinded trial conducted at 17 acute-care hospitals across Australia/New Zealand from 2014 to 2018. Participants with aphasia following acute stroke were randomized to receive usual care (direct usual care aphasia therapy), or one of two higher intensity regimens (20 sessions of either non-prescribed (usual care-plus or prescribed (VERSE) direct aphasia therapy). The primary outcome was improvement of communication on the Western Aphasia Battery-Revised Aphasia Quotient (AQ) at 12 weeks after stroke. Our pre-planned intention to treat analysis combined high intensity groups for the primary outcome. FINDINGS: Among 13,654 acute stroke patients screened, 25% (3477) had aphasia, of whom 25% (866) were eligible and 246 randomized to usual care (n = 81; 33%), usual care-plus (n = 82; 33%) or VERSE (n = 83; 34%). At 12 weeks after stroke, the primary outcome was assessed in 217 participants (88%); 14 had died, 9 had withdrawn, and 6 were too unwell for assessment. Communication recovery was 50.3% (95% CI 45.7-54.8) in the high intensity group (n = 147) and 52.1% (95% CI 46.1-58.1) in the usual care group (n = 70; difference -1.8, 95% CI -8.7-5.0). There was no difference between groups in non-fatal or fatal adverse events (p = 0.72). INTERPRETATION: Early, intensive aphasia therapy did not improve communication recovery within 12 weeks post stroke compared to usual care.