{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T14:29:50Z","timestamp":1773930590548,"version":"3.50.1"},"reference-count":8,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>The international trial AVERT (A Very Early Rehabilitation Trial) found that very early mobilization (VEM; commenced &lt;24 hours after stroke) negatively affected functional outcome (modified Rankin Scale [mRS]). The drivers of this effect remain unclear. One plausible mechanism is that high-dose upright activity worsens cerebral perfusion in patients with cerebral large vessel occlusion (LVO). For this retrospective AVERT substudy, we collected brain imaging from participants from 8 AVERT sites (n=910) to explore the potential relationship between LVO, VEM, and mRS in ischemic stroke. We hypothesized that patients with evidence of LVO would be adversely affected by VEM compared with non-LVO patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>In this post hoc analysis of a randomized controlled trial, 2 neurologists independently classified patients with ischemic stroke as having LVO via direct (vessel truncation on computed tomography\/magnetic resonance imaging angiography) or indirect evidence (hyperdense artery sign or established infarction of &gt;2\/3 of an arterial territory) from brain imaging obtained \u22647 days poststroke. The associations between LVO, VEM, and 3- and 12-month mRS was tested using logistic regression, adjusted for age, treatment with thrombolysis, and baseline National Institutes of Health Stroke Scale.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Interrater reliability for LVO signs was high (weighted \u03ba, 0.842 [95% CI, 0.631\u20130.969]). Of 689 participants (37.2% female; median age, 74.5 [interquartile range, 65.0\u201381.2] years) included in the primary analysis, 192 (28%) showed direct or indirect evidence of LVO. Computed tomography\/magnetic resonance imaging angiography were available in 179 (26%) of those 689 participants. While LVO was associated with poor mRS (&gt;2) at 3 months (adjusted odds ratio, 2.15 [95% CI, 1.29\u20133.64]) and 12 months (adjusted odds ratio, 1.76 [95% CI, 1.1\u20132.84];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.02), there was no significant interaction between VEM, LVO, and mRS (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.16).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>We found no evidence that VEM was specifically harmful in patients with LVO. However, as arterial imaging was not consistently obtained before first mobilization, larger prospective studies with standardized measures of LVO are needed to fully address this question.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?id=1266&amp;isReview=true\">https:\/\/anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?id=1266&amp;isReview=true<\/jats:ext-link>\n              ; Unique identifier: ACTRN12606000185561.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.124.047349","type":"journal-article","created":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T09:00:17Z","timestamp":1744966817000},"page":"1689-1692","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Does Vessel Occlusion Drive the Harmful Effect of Very Early Mobilization in Patients With Ischemic Stroke?: A Post Hoc Analysis of AVERT"],"prefix":"10.1161","volume":"56","clinical-trial-number":[{"clinical-trial-number":"actrn12606000185561","registry":"10.18810\/anzctr"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9848-2666","authenticated-orcid":true,"given":"Tina","family":"Kaffenberger","sequence":"first","affiliation":[{"name":"Stroke Theme, The Florey Institute of Neuroscience and Mental Health (T.K., J.B., V.N.T., H.J., B.C.V.C.), University of Melbourne, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2787-8484","authenticated-orcid":true,"given":"Julie","family":"Bernhardt","sequence":"additional","affiliation":[{"name":"Stroke Theme, The Florey Institute of Neuroscience and Mental Health (T.K., J.B., V.N.T., H.J., B.C.V.C.), University of Melbourne, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6614-8417","authenticated-orcid":true,"given":"Vincent N.","family":"Thijs","sequence":"additional","affiliation":[{"name":"Stroke Theme, The Florey Institute of Neuroscience and Mental Health (T.K., J.B., V.N.T., H.J., B.C.V.C.), University of Melbourne, Australia."},{"name":"Department of Neurology, Austin Health, Heidelberg, Australia (V.N.T.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9807-6606","authenticated-orcid":true,"given":"Leonid","family":"Churilov","sequence":"additional","affiliation":[{"name":"Department of Medicine (L.C.), University of Melbourne, Australia."},{"name":"Departments of Medicine (L.C., G.S., B.C.V.C., N.Y.), Melbourne Brain Centre at the Royal Melbourne Hospital, Australia."},{"name":"Neurology (L.C., G.S., B.C.V.C., N.Y.), Melbourne Brain Centre at the Royal Melbourne Hospital, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2135-0504","authenticated-orcid":true,"given":"Hannah","family":"Johns","sequence":"additional","affiliation":[{"name":"Stroke Theme, The Florey Institute of Neuroscience and Mental Health (T.K., J.B., V.N.T., H.J., B.C.V.C.), University of Melbourne, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gagan","family":"Sharma","sequence":"additional","affiliation":[{"name":"Departments of Medicine (L.C., G.S., B.C.V.C., N.Y.), Melbourne Brain Centre at the Royal Melbourne Hospital, Australia."},{"name":"Neurology (L.C., G.S., B.C.V.C., N.Y.), Melbourne Brain Centre at the Royal Melbourne Hospital, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3632-9433","authenticated-orcid":true,"given":"Bruce C.V.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Stroke Theme, The Florey Institute of Neuroscience and Mental Health (T.K., J.B., V.N.T., H.J., B.C.V.C.), University of Melbourne, Australia."},{"name":"Departments of Medicine (L.C., G.S., B.C.V.C., N.Y.), Melbourne Brain Centre at the Royal Melbourne Hospital, Australia."},{"name":"Neurology (L.C., G.S., B.C.V.C., N.Y.), Melbourne Brain Centre at the Royal Melbourne Hospital, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0685-0060","authenticated-orcid":true,"given":"Nawaf","family":"Yassi","sequence":"additional","affiliation":[{"name":"Departments of Medicine (L.C., G.S., B.C.V.C., N.Y.), Melbourne Brain Centre at the Royal Melbourne Hospital, Australia."},{"name":"Neurology (L.C., G.S., B.C.V.C., N.Y.), Melbourne Brain Centre at the Royal Melbourne Hospital, Australia."},{"name":"Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia (N.Y.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000211"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60690-0"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/0271678X20922457"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1615715"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/svn-2020-000387"},{"key":"e_1_3_3_7_2","first-page":"1012","article-title":"Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography.","volume":"26","author":"Bash S","year":"2005","unstructured":"Bash S, Villablanca JP, Jahan R, Duckwiler G, Tillis M, Kidwell C, Saver J, Sayre J. Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. AJNR Am J Neuroradiol. 2005;26:1012\u20131021. https:\/\/www.ajnr.org\/content\/26\/5\/1012.long.","journal-title":"AJNR Am J Neuroradiol"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.007036"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.561787"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/STROKEAHA.124.047349","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T18:03:11Z","timestamp":1750701791000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/STROKEAHA.124.047349"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":8,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1161\/STROKEAHA.124.047349"],"URL":"https:\/\/doi.org\/10.1161\/strokeaha.124.047349","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]},"assertion":[{"value":"2024-04-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-06","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}