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Exploring post acute rehabilitation service use and outcomes for working age stroke survivors (≤65 years) in Australia, UK and South East Asia: data from the international AVERT trial

Walters R 1 , Collier JM 2 , Braighi Carvalho L 2 , Langhorne P 3 , Katijjahbe MA 4 , Tan D 5 Show all authors , Moodie M 6 , Bernhardt J 7 , AVERT Trialists’ Collaboration

Affiliations 

  • 1 Physiotherapy, Royal Free London NHS Foundation Trust, London, UK
  • 2 Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
  • 3 Academic Section of Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  • 4 Physiotherapy, Hospital Canselor Tuanku Muhriz, Pusat Perubatan UKM, Cheras, Kuala Lumpur, Malaysia
  • 5 Department of Physiotherapy, Singapore General Hospital, Singapore
  • 6 Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
  • 7 Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia julie.bernhardt@florey.edu.au
BMJ Open, 2020 06 11;10(6):e035850.
PMID: 32532772 DOI: 10.1136/bmjopen-2019-035850

Abstract

OBJECTIVES: Information about younger people of working age (≤65 years), their post stroke outcomes and rehabilitation pathways can highlight areas for further research and service change. This paper describes: (1) baseline demographics; (2) post acute rehabilitation pathways; and (3) 12-month outcomes; disability, mobility, depression, quality of life, informal care and return to work of working age people across three geographic regions (Australasia (AUS), South East (SE) Asia and UK).

DESIGN: This post hoc descriptive exploration of data from the large international very early rehabilitation trial (A Very Early Rehabilitation Trial (AVERT)) examined the four common post acute rehabilitation pathways (inpatient rehabilitation, home with community rehabilitation, inpatient rehabilitation then community rehabilitation and home with no rehabilitation) experienced by participants in the 3 months post stroke and describes their 12-month outcomes.

SETTING: Hospital stroke units in AUS, UK and SE Asia.

PARTICIPANTS: Patients who had an acute stroke recruited within 24 hours who were ≤65 years.

RESULTS: 668 participants were ≤65 years; 99% lived independently, and 88% no disability (modified Rankin Score (mRS)=0) prior to stroke. We had complete data for 12-month outcomes for n=631 (94%). The proportion receiving inpatient rehabilitation was higher in AUS than other regions (AUS 52%; UK 25%; SE Asia 23%), whereas the UK had higher community rehabilitation (UK 65%; AUS 61%; SE Asia 39%). At 12 months, 70% had no or little disability (mRS 0-2), 44% were depressed, 28% rated quality of life as poor or worse than death. For those working prior to stroke (n=228), only 57% had returned to work. A noteworthy number of working age survivors received no rehabilitation services within 3 months post stroke.

CONCLUSIONS: There was considerable variation in rehabilitation pathways and post acute service use across the three regions. At 12 months, there were high rates of depression, poor quality of life and low rates of return to work.

TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12606000185561).

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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