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AVERT DOSE | Determining the most effective mobility training program early after stroke

Ongoing uncertainty around the world about the safest and most effective early training approaches after stroke prompted this clinical trial. Using our global network of acute hospitals treating people with stroke, we will recruit more than 2500 patients from over 50 hospitals in Australia, New Zealand, United Kingdom, India, Taiwan, Singapore and Malaysia into the study, testing a range of evidence-informed mobility-based treatment protocols to determine the optimal approach. Physiotherapists and nurses deliver the training which starts within 48 hours of stroke and continues for the acute stay or 14 days (whichever is sooner).

Aims

The main aim of the AVERT DOSE trial is to identify the best early mobility training program for people with ischaemic stroke (i.e. caused by a blood clot in the brain) of mild and moderate severity.

We’re using a new trial design approach called an adaptive clinical trial (full name; multi-arm, multi-stage, covariate-adjusted, response-adaptive randomised clinical trial). The design means that as the trial progresses and the outcomes for each person are known, an algorithm that controls where new patients are randomly allocated adjusts to favour recruitment into the treatments which show most promise. Recruitment commences in 2019 and with the assistance of over 2500 volunteers we expect to have the information we need to roll out new evidence-based training protocols by 2023.

This trial was developed by Professor Julie Bernhardt and a large team of collaborators. See Florey project members as well as national and international collaborators. Full scientific details of the trial protocol are at the Australian New Zealand Clinical Trials Registry. Additional sub-studies will be completed as a part of the trial. We want to understand the relationships between genetics, brain markers (using diffusion tensor imaging), and other brain tests (motor evoked potential) and recovery. We’re interested in pre-stroke factors including physical activity and work and life experience (cognitive reserve) and outcome following stroke. We’ll also gather data that allows us to study the cost-effectiveness of the intervention. Grant funding has been awarded by the Australian National Health and Medical Research Council (#1139712).

Postgraduate students

If you have a background in clinical neuro-rehabilitation, allied health, nursing, medicine, mathematics or statistics and are interested in enrolling in post-graduate studies, please contact us at avertdose@florey.edu.au. Students will be located at the Heidelberg Campus, Victoria, Australia.

Futher trial information can be found on twitter: @AVERTDOSEtrial or via email on avertdose@florey.edu.au 

The precede to the AVERT DOSE trial, titled AVERT trial, was published in The Lancet.

  • Research team

    AVERT Early Rehabilitation Research Group
  • Project supervisor

    Professor Julie Bernhardt
  • Project members

    Ms Oriana Borschmann Professor Leonid Churilov Dr Janice Collier Professor Geoffrey Donnan AO Ms Fiona Ellery Dr Kate Hayward Mrs Li Chun Quang Professor Vincent Thijs
  • Collaborators

    Prof Leonid Churilov, Melbourne Medical School, University of Melbourne, Heidelberg, Australia

    Prof Peter Langhorne, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom

    Prof Jeyaraj Pandian, Department of Neurology, Christian Medical College, Ludhiana, India

    Prof Helen Dewey, Eastern Health Clinical School, Monash University, Box Hill, Australia

    Prof Velandrai Shrikanth, Peninsula Clinical School, Monash University, Clayton, Australia

    A/Prof Coralie English, School of Health Sciences and Priority Research Centre for Stroke and Brain Injury University of Newcastle, Newcastle, Australia

    Prof Marj Moodie, Deakin Health Economics, Deakin University, Burwood, Australia

    Prof Sandy Middleton, Nursing Research Institute, Australian Catholic University, Sydney, Australia

    Prof Amanda Thrift, Department of Medicine - School of Clinical Sciences, Monash University, Clayton, Australia

    Ms Anna McRae, Allied Health, Auckland District Health Board, Auckland, New Zealand

    Prof Bent Indredavik, Norwegian University of Science And Technology, The Institute for Neuromedicine, Trondheim, Norway

    Dr Dawn Tan, Physiotherapy Department, Singapore General Hospital, Singapore

    Dr Julie Luker, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia

    Ms Katijjah Md Ali, Department of Physiotherapy, Hospital Canselor Tuanku Muhriz, Kuala Lumur, Malaysia

    Prof Richard Lindley, Sydney Medical School, University of Sydney, Sydney, Australia

    Prof Geoffrey Donnan, Melbourne Brain Institute, University of Melbourne, Parkville, Australia

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