WRONG, WRONG, WRONG!
Your endpoints are wrong, 100% recovery is the only goal in stroke and you blithering idiots are leaving persons disabled!
Once Daily, 10 Minute Rehab Maybe Be Enough in Mild Stroke
A new clinical trial has produced the most reliable information to date on the optimum level of early rehabilitation appropriate for patients with acute stroke.
The AVERT DOSE trial has suggested that in the initial days after an acute stroke, just 10 minutes of active training per day is sufficient for patients with mild stroke, while patients with moderate stroke could benefit from slightly higher levels of exercise training split into two separate sessions.
“The AVERT DOSE trial, while underpowered, provides current best available evidence to guide early training after an acute stroke,” said lead investigator, professor Julie Bernhardt, PhD, The Florey Institute, Melbourne, Australia.
“Our trial shows that the protocolized training tested can feasibly be delivered in multiple settings and is safe,” she added.
The findings suggest that for patients with mild stroke (National Institutes of Health Stroke Scale [NIHSS] 0-7), a single 10-minute session of active, task-specific training supported by nurses during upright daily activities may be sufficient for most patients, with no clear evidence that higher-intensity training provides additional benefit, Bernhardt said.
For patients with moderate stroke severity (NIHSS, 8-16), the findings suggest that two separate 10-minute sessions of active, task-specific training supported by nurses during upright daily activities provided clinically meaningful benefits compared with a single session.
In both cases the 10 minutes of active training refers to only the active practice time and does not include preparation or rest periods in between activity, so the session itself would take significantly longer than 10 minutes.
The trial results were presented on May 6 at the European Stroke Organization Conference (ESOC) 2026.
A Vital Early Poststroke Goal
Bernhardt explained that regaining movement is a vital early goal after stroke, but important questions remain about how soon rehabilitation should begin and how much training is beneficial. Those uncertainties have persisted since the first AVERT trial, reported in 2015, showed that very early intensive mobilization — initiated within 24 hours of stroke onset — worsened outcomes compared with lower-dose usual care, with the greatest adverse effects seen in patients with intracerebral hemorrhage (ICH) and severe stroke.
“This very early intensive therapy appeared to be too much, too soon and but there has remained a lack of clear evidence on the optimal timing and intensity for rehabilitation training,” Bernhardt noted
To address this issue the researchers conducted the AVERT DOSE trial.
For the study, the researchers analyzed data from the original AVERT trial to identify intervention doses with the most favorable safety and efficacy profiles, then evaluated those dosing strategies in the new trial that excluded patients with ICH and severe stroke.
The study enrolled 1000 patients across 50 hospitals in seven countries, including Australia, Brazil, India, Ireland, Malaysia, Singapore, and the UK.
Participants were stratified by stroke severity, with 631 patients in the mild stroke group and 366 in the moderate stroke group and randomly assigned to one of four mobility training regimens.
All interventions were initiated within 48 hours of stroke onset (mean, 38 hours) and continued for 14 days or until hospital discharge. The interventions focused on functional, task-specific upright movement tailored to each patient and delivered by trained physiotherapists.
Participants were stratified by stroke severity, with 631 patients in the mild stroke group and 366 in the moderate stroke group and randomized to one of four mobility training regimens. All interventions were initiated within 48 hours of stroke onset (mean, 38 hours) and continued for 14 days or until hospital discharge.
Optimal Exercise Dose
The interventions emphasized functional, task-specific upright movement tailored to each patient and delivered by trained physiotherapists.
The groups differed by time (10-40 mins) and session frequency (1-4 sessions/d), with varying activity types and intensity as patients progressed. These protocols replaced usual care.
“There was no usual care alone group as usual care is so varied it is difficult to document what it actually is and makes clinical trial results very difficult to interpret,” said Bernhardt.
The primary endpoint — favorable functional outcome(You never do talk to survivors about their definition of favorable, do you?), defined as a modified Rankin Scale score of 0-2 at 3 months — showed no significant differences between the lowest-dose reference group (one 10-minute session daily) and the higher-dose training regimens.
However, a prespecified analysis of clinically meaningful benefit found more than 90% confidence that higher training doses were not clinically meaningfully better than the lowest reference dose — 10 minutes once per day — for patients with mild stroke.
In the moderate stroke group, there was 96% confidence that two 10-minute regimens at different times of day was better than the lowest dose reference arm, and 84% confidence that this difference was clinically meaningful.
A Safe Intervention
Safety results showed no significant differences in deaths or serious adverse events between lowest reference dose and the higher dose regimens.
“Our primary message is that these interventions are safe. We had low rates of death and serious adverse events, and that was across all of the different dose arms in both the mild and moderate groups. That is a very important finding given that the previous AVERT trial had shown harm,” Bernhardt said.
“We’ve also shown that these interventions can be delivered in multiple settings across the world, including in low- and middle-income countries,” she added.
She explained that the 10 minutes of task specific training took place within a longer overall sessions and the exercises were done in bursts, with rest times not included in the exercise times.
“The training was individualized to the patient depending on their deficit but could be something like repeatedly standing up from a chair. It is trying to build control, stamina, and strength. Patients have to be active, and they have to be working to improve their mobility.”
As part of the study publication, the researchers plan to fully characterize the interventions and how they evolved over time, and the protocols will be made publicly available.
“This is the first time we’ve been able to provide any documented rehabilitation strategy for these patients. The strength of this trial is that we have used consistent protocols, and although we didn’t finish the trial as we planned because of the pandemic, this 1000 patient-strong data set is the best we have,” Bernhardt concluded.
‘An Amazing Achievement’
Commenting on the trial, Peter Kelly, MD, clinical professor of neurology at University College Dublin, Dublin, Ireland, said it was “an amazing achievement.”
“This is the best designed and best conducted trial in rehabilitation that we have ever seen. The though that went into eliminating variability was very impressive and the findings are very useful,” he noted.
Kelly added that the lack of any safety concerns was “very reassuring” and “the lessons from AVERT-DOSE trial that will inform the next steps in rehabilitation studies were outstanding.”
The AVERT DOSE trial was funded by the National Health & Medical Research Council of Australia.
