{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:04:28Z","timestamp":1776272668569,"version":"3.50.1"},"reference-count":53,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2020,6,11]],"date-time":"2020-06-11T00:00:00Z","timestamp":1591833600000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1041401"],"award-info":[{"award-number":["1041401"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1058635"],"award-info":[{"award-number":["1058635"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1077898"],"award-info":[{"award-number":["1077898"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1154904"],"award-info":[{"award-number":["1154904"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["386201"],"award-info":[{"award-number":["386201"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute of Health Research","doi-asserted-by":"crossref","award":["HTA Project 12\/01\/16"],"award-info":[{"award-number":["HTA Project 12\/01\/16"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100009309","name":"Northern Ireland Chest Heart and Stroke","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009309","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Singapore Health","award":["SHF\/FG401P\/2008"],"award-info":[{"award-number":["SHF\/FG401P\/2008"]}]},{"DOI":"10.13039\/501100007919","name":"Chest Heart and Stroke Scotland","doi-asserted-by":"publisher","award":["Res08\/A114"],"award-info":[{"award-number":["Res08\/A114"]}],"id":[{"id":"10.13039\/501100007919","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000364","name":"UK Stroke Association","doi-asserted-by":"crossref","award":["TSA2009\/09"],"award-info":[{"award-number":["TSA2009\/09"]}],"id":[{"id":"10.13039\/501100000364","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000923","name":"Australian Research Council","doi-asserted-by":"publisher","award":["0991086"],"award-info":[{"award-number":["0991086"]}],"id":[{"id":"10.13039\/501100000923","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,4,29]]},"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Information about younger people of working age (\u226465 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Hospital stroke units in AUS, UK and SE Asia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients who had an acute stroke recruited within 24 hours who were \u226465 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>668 participants were \u226465 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\u20132), 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>Australian New Zealand Clinical Trials Registry (ACTRN12606000185561).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-035850","type":"journal-article","created":{"date-parts":[[2020,6,12]],"date-time":"2020-06-12T06:05:25Z","timestamp":1591941925000},"page":"e035850","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Exploring post acute rehabilitation service use and outcomes for working age stroke survivors (\u226465 years) in Australia, UK and South East Asia: data from the international AVERT trial"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3927-2666","authenticated-orcid":false,"given":"Rosy","family":"Walters","sequence":"first","affiliation":[{"name":"Physiotherapy, Royal Free London NHS Foundation Trust, London, UK"},{"name":"Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2950-4870","authenticated-orcid":false,"given":"Janice M","family":"Collier","sequence":"additional","affiliation":[{"name":"Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lillian","family":"Braighi Carvalho","sequence":"additional","affiliation":[{"name":"Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Langhorne","sequence":"additional","affiliation":[{"name":"Academic Section of Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Md Ali","family":"Katijjahbe","sequence":"additional","affiliation":[{"name":"Physiotherapy, Hospital Canselor Tuanku Muhriz, Pusat Perubatan UKM, Cheras, Kuala Lumpur, Malaysia"},{"name":"Faculty of Health, Art and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawn","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marj","family":"Moodie","sequence":"additional","affiliation":[{"name":"Deakin Health Economics, Deakin University, Burwood, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2787-8484","authenticated-orcid":false,"given":"Julie","family":"Bernhardt","sequence":"additional","affiliation":[{"name":"Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,6,11]]},"reference":[{"key":"2025121511473137000_10.6.e035850.1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.003661"},{"key":"2025121511473137000_10.6.e035850.2","unstructured":"Deloitte Access Economics . The economic impact of stroke in Australia, 2013."},{"key":"2025121511473137000_10.6.e035850.3","unstructured":"National Institute for Health and Care Excellence . Nice guidance Parkinson's Disease, 2018."},{"key":"2025121511473137000_10.6.e035850.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753-6405.2007.00136.x"},{"key":"2025121511473137000_10.6.e035850.5","unstructured":"Royal College of Physicians . National clinical guideline for stroke 2016. Fifth edn, 2016."},{"key":"2025121511473137000_10.6.e035850.6","unstructured":"Townsend N , Wickramasinghe K , Bhatnagar P . Coronary heart disease statistics 2012, 2012."},{"key":"2025121511473137000_10.6.e035850.7","doi-asserted-by":"crossref","first-page":"17","DOI":"10.17305\/bjbms.2006.3138","article-title":"Five-Year survival-after first-ever stroke","volume":"6","author":"Smajlovi\u0107","year":"2006","journal-title":"Bosn J Basic Med Sci"},{"key":"2025121511473137000_10.6.e035850.8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4061\/2011\/534812","article-title":"The psychology of stroke in young adults: the roles of service provision and return to work","volume":"2011","author":"Morris","year":"2011","journal-title":"Stroke Res Treat"},{"key":"2025121511473137000_10.6.e035850.9","doi-asserted-by":"publisher","DOI":"10.1080\/09638280400008990"},{"key":"2025121511473137000_10.6.e035850.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(00)90142-4"},{"key":"2025121511473137000_10.6.e035850.11","doi-asserted-by":"publisher","DOI":"10.1177\/0269215506071784"},{"key":"2025121511473137000_10.6.e035850.12","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2012.711895"},{"key":"2025121511473137000_10.6.e035850.13","doi-asserted-by":"publisher","DOI":"10.1310\/tsr1601-20"},{"key":"2025121511473137000_10.6.e035850.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60690-0"},{"key":"2025121511473137000_10.6.e035850.15","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1212\/WNL.0000000000007937","article-title":"Early mobilization and quality of life after stroke. findings from AVERT","volume":"93","author":"Cumming","year":"2019","journal-title":"Neurology"},{"key":"2025121511473137000_10.6.e035850.16","unstructured":"The statutes of the Republic of Singapore . Retirement and re-employment act (Chapter 274A, 2012: 1\u201330."},{"key":"2025121511473137000_10.6.e035850.17","doi-asserted-by":"publisher","DOI":"10.3310\/hta21410"},{"key":"2025121511473137000_10.6.e035850.18","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.19.5.604"},{"key":"2025121511473137000_10.6.e035850.19","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.32.4.871"},{"key":"2025121511473137000_10.6.e035850.20","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)93206-O"},{"key":"2025121511473137000_10.6.e035850.21","doi-asserted-by":"publisher","DOI":"10.1191\/0269215503cr650oa"},{"key":"2025121511473137000_10.6.e035850.22","unstructured":"World Health Organization . International classification of functioning, disability and health: ICF. World Health Organization;, 2001."},{"key":"2025121511473137000_10.6.e035850.23","first-page":"48","article-title":"Assessment of motor function in stroke patients","volume":"65","author":"Lincoln","year":"1979","journal-title":"Physiotherapy"},{"key":"2025121511473137000_10.6.e035850.24","doi-asserted-by":"publisher","DOI":"10.1177\/026921559701100108"},{"key":"2025121511473137000_10.6.e035850.25","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.594598"},{"key":"2025121511473137000_10.6.e035850.26","doi-asserted-by":"publisher","DOI":"10.1023\/A:1008815005736"},{"key":"2025121511473137000_10.6.e035850.27","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-842X.2005.tb00063.x"},{"key":"2025121511473137000_10.6.e035850.28","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.132.2.164"},{"key":"2025121511473137000_10.6.e035850.29","unstructured":"International Monetary Fund . World Economic Outlook: Uneven Growth\u2014Short- and Long-Term Factors. Washington, 2015."},{"key":"2025121511473137000_10.6.e035850.30","unstructured":"Malaysian Society of Neurosciences, Academy of Medicine Malyasia, Ministry of Health Malaysia . Clinical practice guidelines. management of ischaemic stroke. 2nd Edn, 2012: 1\u201364."},{"key":"2025121511473137000_10.6.e035850.31","unstructured":"Ministry of health . stroke and transient ischaemic attacks assessment,investigation,immediate management and secondary prevention. In: MOH clinical practice guidelines, 2009."},{"key":"2025121511473137000_10.6.e035850.32","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-018-36154-0","article-title":"Profile and outcome of post stroke patients managed at selected public primary care health centres in Peninsular Malaysia: a retrospective observational study","volume":"8","author":"Abdul Aziz","year":"2018","journal-title":"Sci Rep"},{"key":"2025121511473137000_10.6.e035850.33","article-title":"Early supported discharge Trialists. early supported discharge services for people with acute stroke","volume":"7","author":"Langhorne","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121511473137000_10.6.e035850.34","unstructured":"Royal College of Physicians . Intercollegiate Stroke Working Party. In: National clinical guidelines for stroke. Third Edn. London, 2008."},{"key":"2025121511473137000_10.6.e035850.35","unstructured":"National Stroke Foundation . Clinical guidelines for stroke rehabilitation and recovery, 2005."},{"key":"2025121511473137000_10.6.e035850.36","unstructured":"National Stroke Foundation . Clinical guidelines for acute stroke management. Melbourne, 2007."},{"key":"2025121511473137000_10.6.e035850.37","doi-asserted-by":"publisher","DOI":"10.12968\/bjon.2010.19.4.46787"},{"key":"2025121511473137000_10.6.e035850.38","unstructured":"Australian Institute of health and welfare (AIHW) . Heart, stroke and vascular diseases\u2014Australian facts 2004. In: Cardiovascular Disease Series No 22, 2004."},{"key":"2025121511473137000_10.6.e035850.39","unstructured":"Australian Institute of health and welfare (AIHW) . stroke and its management in Australia: an update. In: Cardiovascular disease series. 158, 2013."},{"key":"2025121511473137000_10.6.e035850.40","unstructured":"Australian Stroke Coalition Rehabilitation Working Group . Assessment for rehabilitation: pathway and decision-making tool 2012. Melbourne: Australian Stroke Coalition, 2012."},{"key":"2025121511473137000_10.6.e035850.41","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31824367ab"},{"key":"2025121511473137000_10.6.e035850.42","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.59.1.26"},{"key":"2025121511473137000_10.6.e035850.43","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-004-0583-0"},{"key":"2025121511473137000_10.6.e035850.44","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000217652.42273.02"},{"key":"2025121511473137000_10.6.e035850.45","unstructured":"Stroke Foundation . Chapter 6 clinical guidelines for stroke management. living guidelines, 2019. Available: https:\/\/informme.org.au\/en\/Guidelines\/Clinical-Guidelines-for-Stroke-Management [Accessed 12 Nov 2019]."},{"key":"2025121511473137000_10.6.e035850.46","doi-asserted-by":"publisher","DOI":"10.1080\/09638280210142167"},{"key":"2025121511473137000_10.6.e035850.47","unstructured":"Stroke Foundation . National stroke audit. rehabilitation services report 2018 2018."},{"key":"2025121511473137000_10.6.e035850.48","first-page":"1","article-title":"How can stroke care be improved for younger service users? A qualitative study on the unmet needs of younger adults in inpatient and outpatient stroke care in Australia","volume":"7","author":"Shipley","year":"2019","journal-title":"Disabil Rehabil"},{"key":"2025121511473137000_10.6.e035850.49","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.534487"},{"key":"2025121511473137000_10.6.e035850.50","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1177\/0308022615624710","article-title":"Outcomes of return-to-work after stroke rehabilitation: a systematic review","volume":"79","author":"Wei","year":"2016","journal-title":"British Journal of Occupational Therapy"},{"key":"2025121511473137000_10.6.e035850.51","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.503219"},{"key":"2025121511473137000_10.6.e035850.52","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0041795"},{"key":"2025121511473137000_10.6.e035850.53","doi-asserted-by":"publisher","DOI":"10.1310\/tsr1805-562"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-035850","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T19:47:42Z","timestamp":1765828062000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-035850"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6]]},"references-count":53,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6,11]]},"published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1136\/bmjopen-2019-035850"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-035850","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6]]}}}