AVERT News 2009
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A Stroke of Good Luck
Belmont Hospital stroke unit physiotherapist Owen Katalinic said that early intervention is important in recovering from stroke. “Not only is this an exciting new concept for patients, but the stroke team at Belmont Hospital will benefit too.”
Source. Health Matters. (September 2009). Edition 43, 10. 
HNE Health matters.pdf
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Stroke Delays
“Two in every five stroke sufferers wait at least a day before going to hospital, a world-first study has found.”
Source. Sunday Herald Sun. 20 September 2009 page 28.
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Australian led stroke rehabilitation trial now the world’s largest
18 hospitals in Australia, New Zealand and Scotland have recruited 500 patients to A Very Early Rehabilitation Trial (AVERT). This means that this research is now the largest stroke rehabilitation trial across the globe. This achievement represents a strong commitment from physiotherapists and nurses to study ways to improve stroke patient outcomes. Recruitment is moving toward a target of over 2000 patients with the trial expanding internationally, with new hospitals in Wales, Ireland, Singapore and Malaysia to commence recruitment this year.
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Around Austin Health last week
Austin Health entered the 500th patient into the international AVERT study (which stands for ‘A Very Early Rehabilitation Trial’) into stroke. Patient Maureen Hancock celebrated her recruitment into the study with trial coordinator Ros Melling, physiotherapist, Niamh McDonagh and nurse Sue Vanselow, who have been participating in the trial for the last two years, looking at ways to help stroke patients recover more quickly.
Source. Week at a Glance, Austin Health Weekly Staff Newsletter, 10 August 2009 page 3. Week at a Glance 10 August 2009.pdf
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New stroke rehabilitation research starts in Wales
A new international stroke trial (called AVERT) that provides early exercise therapy within 24 hours of stroke has commenced in Wales …“We are excited that two enthusiastic stroke unit teams from the Royal Gwent Hospital and the Nevill Hall Hospital in Wales are joining the research team.”
Source. NSRI News release 15 June 2009 news release Wales FINAL.pdf
AVERT News 2008
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Stroke study to test early rehab
Four Scottish hospitals are to take part in an international study to see whether early rehabilitation can aid stroke patients. Stirling Royal Infirmary, Monklands, Wishaw General and Glasgow's Western Infirmary will join the study over the next four years.
Source. BBC News UK. 21 October 2008
http://news.bbc.co.uk/2/hi/uk_news/scotland/tayside_and_central/7680514.stm
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Very early exercise after stroke helps mood
New research has shown that getting patients up, out of bed and walking soon after stroke helps mood symptoms. With current hospital care, more than 40% of patients report multiple symptoms of depression such as poor appetite, disturbed sleep and sadness in the first seven days after stroke. In contrast, only 20% of patients provided with an early active exercise program described symptoms of severe depression.
Cumming, T. B., J. Collier, A.G. Thrift, J. Bernhardt(2008). "The effect of very early mobilization after stroke on psychological well-being." Journal of Rehabilitation Medicine 40: 609-614.
Caroline Cassells. 30 September 2008. Medscape Today. Medscape Health News. Very Early Mobilization Cuts Rates of Poststroke Depression by 50% http://www.medscape.com/viewarticle/581337
Megan Rauscher. October 3 2008. Reuters. Exercise soon after stroke may boost outlook http://www.reuters.com/article/healthNews/idUSTRE4927ZV20081003?feedType=RSS&feedName=healthNews
Source. NSRI Media Release 30 September
Web Source http://jrm.medicaljournals.se/issue/40/8
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Not all stroke units are the same: A comparison of physical activity patterns in Melbourne, Australia and Trondheim, Norway
“Higher activity levels were observed in Trondheim patients, particularly among those with more severe strokes. A greater emphasis on mobilization may make an important contribution to improved outcomes.” Bernhardt, J., Chitravas, N., Lidarende, M. I., Thrift, A.G. & Indredavik, B. (2008). "Not all stroke units are the same: A comparison of physical activity patterns in Melbourne, Australia and Trondheim, Norway." Stroke 39: 2059-2065.
Web Source http://stroke.ahajournals.org/
“One of the main principles of treatment of patients in stroke units is multidisciplinary care. However, leading priorities of multidisciplinary teams, ie. the general strategy of therapy, can vary. Comparison of different stroke units, such as in this article, is of great importance.”
Veronika Skvortsova: Faculty of 1000 Medicine, 28 Aug2008 http://www.f1000medicine.com/article/id/1118916/evaluation.
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Building the evidence-base for early mobilization of acute stroke patients
“In the case of early mobilization, where considerable controversy exists about what constitutes early mobilization, the importance of developing an evidence base becomes even more pressing.”
Web Source http://www.blackwellpublishing.com/journal.asp?ref=0962-1067&site=1
Journal details: Fiona Ellery and Julie Bernhardt (2008) "Commentary on Arias M & Smith L (2007) Early mobilization of acute stroke patients. Journal of Clinical Nursing 16, 282-288." Journal of Clinical Nursing 17(14): 1957.
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Controversies, the unknowns and a way forward
“This paper aims to provide an overview of the topic of very early mobilization (VEM).
Section 1 reviews the effects of bed rest and outlines arguments both for and against enforced bed rest after stroke.
Section 2 VEM as a treatment for stroke and the limitations of existing literature in the field are described.
Section 3 outlines the systematic approach that has been taken by our team of clinical researchers to the study of the effect of VEM after stroke.”
Web Source http://www.annalsofian.org/advancesearch.asp
Journal details: Julie Bernhardt (2008). "Very early mobilization following acute stroke: Controversies, the unknowns and a way forward." Annals of Indian Academy of Neurology: S88-98.
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AVERT goes international
Kerry Scott, Interviewer. “First of all – what is AVERT? What does it stand for?”
Jacqui Ancliffe, Senior Physiotherapist at Royal Perth Hospital “AVERT stands for A Very Early Rehabilitation Trial and at the Royal Perth Hospital, we are one of eleven centre around Australia. This year we have gone international and New Zealand, Scotland and Canada are soon coming on line as we need to recruit over 2,000 people for this trial.
Source:.Radio Freemantle. http://www.radiofremantle.com/
Interview by Kerry Scott, with Jacqui Ancliffe, Wednesday May 7 2008 at 10:00.
Click here to listen to the podcast.
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AVERT: Very Early Exercise Safe Following Acute Stroke
“New 3-month safety results from a large multicenter, single-blind, phase 3 show that at 5.8% death rates are low and adverse events acceptable in the trials first 170 acute ischemic stroke patients….”
Source: Caroline Cassels. Medscape Medical News. May 23, 2008
Click here to read. http://www.medscape.com/viewarticle/574977
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Auckland City Hospital joins international stroke rehabilitation research
“Its great to be involved in a study that could make such a difference to stroke patients. There is the potential for less disability and a better quality of life after stroke, just by getting patients up and about earlier and more often” says Gemma Wavish, physiotherapist Auckland District Health Board.
Source: Te Whetu Marame NOVA, The official newsletter of the Auckland District Health Board. http://www.adhb.govt.nz/news/NOVA/NOVA%20June%20web.pdf
According to Stroke Foundation CEO, Mark Vivian: “There is a huge need for improved stroke rehabilitation in New Zealand. We are encouraged by the AVERT initiative as there is still currently just one DHB nationally who provides stroke rehabilitation in accordance with the Stroke Guidelines approved in 2003.
Source: Stroke Foundation of New Zealand Inc. (Spring 2008). Auckland City Hospital first to join AVERT trial in New Zealand. Forward, Issue 17, page 2.
http://www.stroke.org.nz/newsletters/newsletters.html
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The INTERNET STROKE CENTRE
A Very Early Rehabilitation Trial (AVERT)
Trial Status: Ongoing. Trial began in July 2006 and is currently recruiting subjects with 214 enrolled as of December 2007 and a recruitment period of 3.5 years expected.
Web Site Update 1 April 2008. http://www.strokecenter.org/trials/TrialDetail.aspx?tid=723
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World record for patient trial
“Girrawheen resident Robert Vreedenburgh’s recruitment into A Very Early Rehabilitation Trial (AVERT) has broken a world record.”
Source: Wanneroo Times. Tuesday 29/04/2008, page 2. Click here to read. wanneroo times 1 page.pdf
“AVERT (A Very Early Rehabilitation Trial) is now the largest rehabilitation stroke study in the world thanks to Royal Perth Hospital”
Source: Servionews. An official publication produced by the Royal Perth Hospital. March 2008. page 2. Click here to read. http://www.rph.wa.gov.au/servio.html
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At the Royal Perth Hospital, Jacqueline Ancliffe (AVERT Main Investigator) with Robert Vreedenburgh who is the record breaking AVERT stroke patient number 223. |
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“A Very Early Rehabilitation Trial for Stroke (AVERT)
Phase II Safety and Feasibility
”
“Very early mobilization of patients within 24 hours of acute stroke appears safe and feasible. Intervention efficacy and cost effectiveness are currently being tested in a large randomized controlled trial.” Julie Bernhardt, Helen Dewey, Amanda Thrift, Janice Collier, and Geoffrey Donnan.
Source: Bernhardt, J., Dewey, H., Thrift, A., Collier, J., & Donnan, G. (2008). A Very Early Rehabilitation Trial for Stroke (AVERT): Phase II Safety and Feasibility. Stroke, 39, 390-396. http://stroke.ahajournals.org/
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“Julie Bernhardt wins top award”
December 13, 2007. Julie Bernhardt was awarded the Physiotherapy Achievement Award 2007 from the Australian Physiotherapy Association (Victorian Branch). The award is for her outstanding contribution to the advancement in the areas of neurology and gerontology, collaborative research, mentoring of colleagues and her passionate commitment to the interests of stroke survivors.
Source: Physiotherapy Inmotion, The magazine of the Australian Physiotherapy Association. February 2008. page 47. Click here to read. 2008 February InMotion.pdf
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Keith Hill (left) and Anne McGann (right) congratulate Julie Bernhardt on receiving her award at the Victorian Branch, Australian Physiotherapy Association. |
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AVERT Newsletter No. 6 December 2007. NEWS FLASH
Professor Peter Langhorne, Olivia Wu, Julie Bernhardt, Matthew Walters, Claire Ritchie, Lorraine Smith have just found out that they have been successful in gaining funding from Chest Health and Stroke Scotland. Peter has written to us “A nice wee present - just heard that the AVERT Scotland proposal has been funded (almost £90,000). Lots of work to do now but happy days.” This means that is 2008 we will commence some AVERT sites in Scotland.
Source: National Stroke Research Institute, A Very Early Rehabilitation Trial. (AVERT) avert-newsletter6-Dec07.pdf
AVERT News 2007
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“AVERT Phase III Protocol On-line”
The AVERT Phase III Very Early Rehabilitation protocol has now been posted on the Lancet Protocol Reviews website. The Lancet is a highly respected medical journal, and this is a very important recognition for the trial. One of the protocol reviewers said “This is a very important trial, the result of which could have a major impact on routine clinical practice in stroke medicine.”
Source: Lancet Protocol Review: Protocol 06PRT/5424: A Very Early Rehabilitation Trial (AVERT): phase III (Australian Clinical Trials Registry: 1260600185561). Published on-line July 2007 http://www.thelancet.com/journals/lancet/misc/protocol/06PRT-5424
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“I can stand now, with help”
“94 year old Jean Armstrong suffered a stroke a few weeks ago. Her recovery has been nothing short of remarkable. “ Click here to hear the 2 minute podcast.
Source: Sky Health News Australia Podcast. 13 January 2007. Used with permission. http://www.skynews.com.au/podcast/
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International collaboration between the National Stroke Research Institute, Australia and the Karolinska University Hospital, Sweden
Marie Halvorsen (Physiotherapist), Sahereh Roshandel (Nurse) and Agneta Stoker (Nurse Assistant) are undertaking an evaluation of the level of physical activity of patients managed in the stroke unit at the Karolinska University Hospital, Stockholm, Sweden. The Very Early Rehabilitation team at the National Stroke Research Institute will provide supporting expertise and technology, based on initial work done by Bernhardt et al (2004, Stroke 35: 1005-1009).
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From left: Marie Halvorsen (Physiotherapist), Agneta Stoker (Nurse Assistant) and Sahereh Roshandel (Nurse) during training on the stroke unit ward at the Austin Hospital, Melbourne, Australia
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“Novel Stroke Rehabilitation Programs Target Patients Earlier,…”
April 3, 2007. News from the International Stroke Conference. “Patients who participated in assisted physical activity begun in the first 24 hours after a stroke had no significant increase in serious adverse events, including severe falls or inability to mobilize because of rapid blood pressure drops” p30.
Source: Charlene Laine. Neurology Today. Page 30. To obtain a copy of this article, contact Neurology Today (add web site). http://www.neurotodayonline.com/
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Stroke rehabilitation trial at West Gippsland Hospital
February 13, 2007. West Gippsland Hospital was selected as the only rural hospital in Australia to participate in a national stroke rehabilitation trial.
Source: Warrigal/Drouin Gazzette. Page 20. Warrigal Drouin Gazette.pdf
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At West Gippsland Hospital (WGH), Molly Hewitt stroke patient (front) is supported by her husband Edwin, and the AVERT team at WGH.
Rear: Edwin Hewitt (husband), Bernie McKenna (Physiotherapy Manager), Richard Adams (physiotherapist), Casey Banks (Nurse), Fiona Ellery (NSRI Trial Manager), Kandi Burke (Physiotherapist and Assessor)
Middle: Susan Smith (WGH Trial co-ordinator), Sara Hewitt (Nurse) |
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Rehab after stroke – Don’t waste a minute
“In 1950 my father had a stroke, and his doctor insisted on 6 weeks’ bed rest as part of the treatment. His recovery was not very good. Now-a-days the bed rest would be regarded as totally wrong.”
Source: Posted on Sun, February 25, 2007 at 03:34AM by Robert Griffith in Heart Health, February 09, 2007. http://www.health-and-age.org/health-topics-/2007/2/18/rehab-after-a-stroke-dont-waste-a-minute.html
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Editorial. Advancing Rehabilitation Clinical Trials Design
“So, how do we improve the quality of clinical trial design and its reporting?”. p 52.
Source: Bernhardt J. International Journal of Therapy and Rehabilitation Volume 14, Issue 2, page 52. February 2007.
To request a copy of this article, email the author, Dr Julie Bernhardt avert@nsri.org.au
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ASA: Physical Activity Safe Within 24 Hours of Stroke
SAN FRANCISCO, Feb. 9 -- Getting selected patients out of bed and moving in the first 24 hours after a stroke appears to be safe, Australian researchers said here.
Source: Crystal Phend, Staff Writer, medpage TODAY. February 09, 2007. http://www.medpagetoday.com/tbprint.cfm?tbid=5029&topicid=48
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AVERT: Exercise Therapy Feasible, Safe within 24 Hours of Stroke Onset
February 14, 2007 (San Francisco) — A new pilot study shows that getting acute stroke patients out of bed and engaging them in exercise therapy within 24 hours of symptom onset is a feasible and safe form of rehabilitation.
English http://www.medscape.com/viewarticle/552208
Japanese http://ubm46671.at.webry.info/200703/article_15.html
Chinese http://www.24drs.com/Professional/list/content.asp?x_idno=4373&x_classno=5&x_chkdelpoint=Y
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New early rehabilitation research for stroke
Associate Professor Julie Bernhardt presented the results of the new acute trial at the American Stroke Association’s International Stroke Conference, 2007. “We have found that exercise therapy (with a focus on mobilization) can be started very early, patients are not too tired and it appears safe”, said Dr Julie Bernhardt, physiotherapist and AVERT Program Director.
Source: News release, National Stroke Research Institute. Click here to read. NSRI ASA ISC news release 8 February 2007.pdf and
News media slides are also attached. ASA ISC media slides.ppt
AVERT News 2006
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20 years in stroke rehabilitation: Trials, tribulations and tomorrow
Stroke Foundation: Health Professionals Day. The “Putting Research into Practice” was held on the 30th October, 2006. The presentation by Julie Bernhardt is now available in pdf format. Click here to read. Bernhardtkeynote.pdf
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Austin launches major stroke trial
“The Austin is the first Australian hospital to launch the final phase of the ‘AVERT’ very early rehabilitation trial.”
Source: Physiotherapy inmotion, The magazine of the Australian Physiotherapy Association. November 2006. page 30.
Click here to read. 2006 Nov Physiotherapy inmotion.pdf
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Avert at Austin Health, Melbourne. Left to Right: Tara Sharply, (main investigator), Mark Hindson, (physiotherapist), Dr Julie Bernhardt (program director) and Cathy Nall (Director of physiotherapy). |
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Annual Conference, Stroke Society of Australia, Adelaide. October 2006
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Helen Dewey, Julie Bernhardt, Janice Collier and Mandy Thrift wearing AVERT t-shirts to promote AVERT Phase III at the Annual Conference, Stroke Society of Australia, Adelaide, October 2006. |
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Stroke week
“During stroke week, Royal Perth Hospital started recruiting patients for an Australia wide study of very early stroke rehabilitation (AVERT).”
Source: Servionews. An official publication produced by the Royal Perth Hospital. October 2006. page 6.
Click here to read. http://www.rph.wa.gov.au/servio.html
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AVERT at Royal Perth Hospital, Perth. Left to right: Melissa Singleton (nurse), Jenny Reynolds (nurse), Robyn Lim (nurse), Sala Nanthakumar (nurse), Jacqui Ancliffe (main investigator), Melita Field (physiotherapist).
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Flinders recruiting patients for national stroke study
“Flinders Medical Centre has been selected to take part in a national study that will test the effectiveness of very early rehabilitation for patients who have had a stroke.”
Source: fmconnect. The internal newsletter of the Flinders Medical Centre. October 2006. page 1. Click here to read. 2006 Oct FMConnect.pdf
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AVERT at Flinders Medical Centre, Adelaide. Back: Craig Wood (physiotherapist), Dianne Benham (), Julie Luker (main investigator), Fiona Ellery (project manager), Janice Collier (program manager), Tyson Baird () Front: Deanne Kearns (nurse), Michelle Broncha (nurse), Tina Pearson (nurse), Julie Bernhardt (program director).
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A Very Early Rehabilitation Trial (AVERT)
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Australia-wide trial on very early rehabilitation after stroke
“Not only will we determine whether very early rehabilitation saves lives and reduces disability, we will also look at the cost effectiveness of the intervention”
Source: human services news, Department of Human Services, Victoria. July 2006. Vol 5, No 6. page 3. Click here to read. 2006 Jul Human Services News.pdf
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Melbourne AVERT investigators meeting
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Melbourne July 14th 2006 met to gear up for the multi-center AVERT early rehabilitation trial.
Picture: AVERT Investigators from Austin Health, Western Gippsland Hospital, Royal Perth Hospital, Flinders Medical Centre, Westmead Hospital |
Media News 2005
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Rehab study holds hope
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Source: Valley Weekly, October 19th. 2005. Fairfax Community Newspapers. Click here to read. 2005 Oct 19 Valley Weekly.pdf
Picture: AVERT patient Jean Fraser (left) with Program Director, Associate Professor Julie Bernhardt (rear), and AVERT nurse Suzanne Seroti (right). |
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Physiotherapist-led team secures $2.8 million
The Australian National Health and Medical Research Council has provided $2.8 million to sponsor Phase III of the trial from 2006 to 2010.
A Very Early Rehabilitation Trial (AVERT) represents the first large, multi-center randomised controlled trial comparing very early rehabilitation (with a focus on mobilisation) with standard care to determine its efficacy and cost-effectiveness.
Getting patients up and about within 24 hours of suffering a stroke is the focus of new research aiming to save lives and reduce disability.
Source: Physiotherapy inmotion, The magazine of the Australian Physiotherapy Association. November 2005. page 27. Click here to read. APAInmotionNov05.pdf
This trial has been registered at the Australian Clinical Trials Registry: ACTRN012606000185561.
For details please refer to http://www.actr.org.au/
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Picture: Some of the AVERT team celebrating the successful grant application From the left: Janice Collier (Program Manager), Carolyn Luke (Research Physiotherapist, St. Vincent’s Hospital), Dorcas Quah (Research Officer), Julie Bernhardt (Program Director).
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Research to help reduce stroke-related disability
Source: The Age, Saturday October 29 2006. page 27. Click here to read. 2006 Oct 29 The Age.pdf
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Stroke study world first
Source: Heidelberg Leader, April 12 2005. Click here to read. 2005 Apr 12 Heidelberg Leader.pdf
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Heidelberg researcher attracts $185,000 in Heart Foundation Funding for 2005
Grants from the National Heart Foundation
Source: Heart Foundation media release 11 March, 2005. Click here to read. HeartFoundMar05.pdf
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Tara’s fellowship is no stroke of luck
“Austin Health Physiotherapist, Tara Sharply has been awarded the FJ O’Rourke Fellowship and will use it to continue her work in stroke rehabilitation by traveling to Norway.”
Source: The Age. Saturday January 29 2005. Click here to read. 2005 Jan 29 The Age Tara.pdf
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Fellowship win for stroke physiotherapist
“Ms Sharpley will gain first-hand experience of the very early mobilisation (VEM) stroke-intervention technique at a leading stroke unit at Saint Olav’s Hospital in Norway”
Source: Department of Human Services, Victoria. 4 February 2005. Click here to read.
PhysiotherapyFeb05.pdf
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Tara Sharpley (Austin physiotherapist) and Anne Loege (St Olavs physiotherapist) at the Stroke Unit, St Olavs Hospital, Norway. |
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People Often Inactive, Alone After a Stoke
“In the early days after having a stroke, most patients spend most of their time alone resting in bed, when they should be encouraged to be active. "The amount of activity currently occurring among stroke patients in some hospitals is very minimal," Bernhardt told Reuters Health, "and these levels may not represent the early rehabilitation that we believe is or should be happening as part of organized stroke care."
Source: W Boggs, Reuters Health News: 25 April 2004. Click here to read. http://www.virtualcancercentre.com/news.asp?artid=1433
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Inactive and alone: Physical activity within the first 14 days of acute stroke unit care
“During the therapeutic day, patients spend more than 50% resting in bed, 28% sitting out of bed and only 13% engaged in activities with the potential to prevent complications and improve recovery of mobility” page 1005.
Source: Bernhardt J, Dewey HM, Thrift AG, Donnan GA. Stroke 2004:35, 1005-1009. This article is available at the Stroke journal web site. http://stroke.ahajournals.org/content/vol35/issue4/
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AVERT NEWSLETTER– Information for research program staff and stroke survivors
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National Stroke Research Institute