OBJECTIVETo determine whether early and more frequent mobilization after stroke affects health-related quality of life.
METHODSA 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.
RESULTSNo 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 (p = 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 p < 0.001). Quality of life in AVERT participants was substantially lower than population norms, and the gap increased with age.
CONCLUSIONSEarlier and more frequent mobilization after stroke did not influence quality of life.
CLINICAL TRIAL REGISTRATIONanzctr.org.au; ACTRN12606000185561
CLASSIFICATION OF EVIDENCEThis 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.
Engineering Geology Price, David George
2008, 2009, 2008-02-15, 20090401
eBook
Thisbook is directed at the heart of Engineering Geology, where geology is used to identify potential problems arising from ground conditions; it describes how to investigate those conditions and to ...define an engineering response that will either avoid or reduce or even eliminate the problems revealed.It has written for students of geology, engineering geology and civil engineering and illustrates how geology is related to calculations of stability, deformation and groundwater flow. The reader is constantly presented with the "big geological picture" that is so often lacking, when only site details are available, and yet so necessarywhen an adequate engineering solutionis tobe found.
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