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Critique of A Very Early Rehabilitation Trial (AVERT).

Based on a large multicenter/intercontinental patient population, the A Very Early Rehabilitation Trial (AVERT) suggests that early intensive mobilization procedures negatively affect 3-month outcome in severely affected stroke victims and in patients with intracerebral hemorrhage. This unexpected finding is interpreted in view of the limitations of the trial. It is argued that these results should not lead to prolonging immobilization and inactivity after stroke and to a cessation of clinical research that aims at integrating rehabilitative intervention into acute stroke care.

The AVERT trial is the largest randomized multicenter trial conducted in stroke rehabilitation to date. It compares very early mobilization within 24 hours after symptom onset with usual care in patients with ischemic or hemorrhagic stroke without significant coexisting comorbidity or premorbid disability.

The authors are to be complimented to have achieved this high quality collection of data across 5 countries in 3 continents (Australia/New Zealand, Europe, and Asia). Rehabilitation interventions are difficult to test in multicenter trials because they often lack standardization and involve a great deal of human effort on the side of the therapist and the patient. This complexity is even higher in the acute phase after stroke where time is short for meeting all acute care requirements, that is, treating the acute event, finding its cause, and preventing complications. The …