From Florey Institute of Neuroscience and Mental Health (T.B.C., L.C., J.C., G.D., F.E., J.B.), University of Melbourne; Eastern Health Clinical School (H.D.) and Department of Medicine, School of Clinical Sciences at Monash Health (A.G.T.), Monash University, Melbourne, Australia; Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK; Westmead Hospital Clinical School (R.I.L.), University of Sydney and George Institute for Global Health, Sydney; Faculty of Health (M.M.), Deakin University, Melbourne, Australia.
Neurology. 2019 Aug 13;93(7):e717-e728. doi: 10.1212/WNL.0000000000007937. Epub 2019 Jul 26.
To determine whether early and more frequent mobilization after stroke affects health-related quality of life.
A Very Early Rehabilitation Trial (AVERT) was an international, multicenter (56 sites), phase 3 randomized controlled trial, spanning 2006-2015. People were included if they were aged ≥18 years, presented within 24 hours of a first or recurrent stroke (ischemic or hemorrhagic), and satisfied preordained physiologic criteria. Participants were randomized to usual care alone or very early and more frequent mobilization in addition to usual care. Quality of life at 12 months was a prespecified secondary outcome, evaluated using the Assessment of Quality of Life 4D (AQoL-4D). This utility-weighted scale has scores ranging from -0.04 (worse than death) to 1 (perfect health). Participants who died were assigned an AQoL-4D score of 0.
No significant difference in quality of life at 12 months between intervention (median 0.47, interquartile range [IQR] 0.07-0.81) and usual care (median 0.49, IQR 0.08-0.81) groups was identified ( = 0.86), nor were there any group differences across the 4 AQoL-4D domains. The same lack of group difference in quality of life was observed at 3 months. When cohort data were analyzed (both groups together), quality of life was strongly associated with acute length of stay, independence in activities of daily living, cognitive function, depressive symptoms, and anxiety symptoms (all < 0.001). Quality of life in AVERT participants was substantially lower than population norms, and the gap increased with age.
Earlier and more frequent mobilization after stroke did not influence quality of life.
anzctr.org.au; ACTRN12606000185561 CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for people with stroke, earlier and more frequent mobilization did not influence quality of life over the subsequent year.
确定卒中后早期且更频繁的活动是否会影响健康相关的生活质量。
一项超早期康复试验（AVERT）是一项国际性、多中心（56 个地点）、3 期随机对照试验，跨越 2006-2015 年。如果患者年龄≥18 岁，首次或复发性卒中（缺血性或出血性）发病后 24 小时内就诊，且满足预定的生理标准，则纳入研究。参与者被随机分配至仅接受常规护理或在常规护理的基础上接受超早期且更频繁的活动。12 个月时的生活质量是预先指定的次要结局，使用生活质量 4 维度评估量表（AQoL-4D）进行评估。该效用加权量表的评分范围为-0.04（比死亡还差）至 1（完全健康）。死亡的参与者被分配 AQoL-4D 评分为 0。
干预组（中位数 0.47，四分位距 [IQR] 0.07-0.81）和常规护理组（中位数 0.49，IQR 0.08-0.81）在 12 个月时的生活质量无显著差异（ = 0.86），4 个 AQoL-4D 领域也没有组间差异。3 个月时也观察到生活质量无组间差异。当分析队列数据（两组一起）时，生活质量与急性住院时间、日常生活活动独立性、认知功能、抑郁症状和焦虑症状强烈相关（均<0.001）。AVERT 参与者的生活质量明显低于人群正常值，且差距随年龄增长而增大。
卒中后更早且更频繁的活动并不能影响生活质量。
anzctr.org.au；ACTRN12606000185561 证据分类：本研究提供了 II 级证据，表明对于卒中患者，早期且更频繁的活动在随后的 1 年内不会影响生活质量。
