***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND AND PURPOSE This prospect i ve , multicenter study was performed to determine the frequency of symptomatic complications up to 30 months after stroke using prespecified definitions of complications . METHODS We recruited 311 consecutive stroke patients admitted to hospital . Research nurses review ed their progress on a weekly basis until hospital discharge and again at 6 , 18 , and 30 months after stroke . RESULTS Complications during hospital admission were recorded in 265 ( 85 % ) of stroke patients . Specific complications were as follows : neurological-recurrent stroke ( 9 % of patients ) , epileptic seizure ( 3 % ) ; infections-urinary tract infection ( 24 % ) , chest infection ( 22 % ) , others ( 19 % ) ; mobility related-falls ( 25 % ) , falls with serious injury ( 5 % ) , pressure sores ( 21 % ) ; thromboembolism-deep venous thrombosis ( 2 % ) , pulmonary embolism ( 1 % ) ; pain-shoulder pain ( 9 % ) , other pain ( 34 % ) ; and psychological-depression ( 16 % ) , anxiety ( 14 % ) , emotionalism ( 12 % ) , and confusion ( 56 % ) . During follow-up , infections , falls , " blackouts , " pain , and symptoms of depression and anxiety remained common . Complications were observed across all 3 hospital sites , and their frequency was related to patient dependency and duration after stroke . CONCLUSIONS Our prospect i ve cohort study has confirmed that poststroke complications , particularly infections and falls , are common . However , we have also identified complications relating to pain and cognitive or affective symptoms that are potentially preventable and may previously have been underestimated Objective : To investigate whether additional early physiotherapy after stroke improved functional recovery in stroke patients . Design : A prospect i ve , r and omized , controlled study . Setting : One stroke ward and an acute stroke unit in a large teaching hospital , southern China . Subjects : Patients with first-onset stroke consecutively admitted to the stroke centre . Interventions : One group ( n = 78 ) received additional early physiotherapy ( AEP ) for 45 minutes , five days a week for four weeks starting within the first week since stroke onset ; the routine therapy ( RT ) group ( n = 78 ) received no professional rehabilitation therapy . Main outcome measures : Glasgow Coma Scale , Mini-Mental State Examination , Fugl-Meyer Assessment of Motor Recovery , Clinical Neurological Deficit Scale and Modified Barthel Index ( MBI ) . Results : Patients from the AEP group had a high drop-out rate ( n = 28 ) , but those remaining made relatively better functional recovery at 30 days than those from the RT group if measured by MBI . Multiple linear regression analysis revealed that cognitive disturbance , aphasia , double incontinence , site of lesion and sensory impairment might affect functional recovery after stroke . Conclusions : Additional early physiotherapy might improve independence of patients after stroke but failed to show benefit in other aspects in our study . Cognitive disturbance , aphasia , double incontinence , site of lesion as well as sensory impairment might affect functional outcome after stroke OBJECTIVE To examine rehabilitation interventions and result ing physical activity patterns of patients managed in acute stroke units to help inform development of a r and omized controlled trial of very early rehabilitation . DESIGN An open observational study of patient activity and therapist report of patient interventions . A survey of stroke unit re sources . METHODS Patients less than 14 days post-stroke from 5 metropolitan stroke units were observed over 2 consecutive weekdays at 10-minute intervals between 08.00 h and 17.00 h. Physical activity , location and person(s ) present were ascertained at each observation . Therapists completed treatment records . Senior staff completed stroke unit surveys . RESULTS Patients after stroke ( n=58 ) were with therapists 5.2 % of the observed day . Few patients ( 17.1 % ) received  daily therapy  by more than one therapist . When patients received therapy , average session times were 24 minutes of physiotherapy , 23 minutes of occupational therapy and 33 minutes of speech pathology .  The more time that family members were present , the longer the treatment time . Four to 11 min of upper-limb therapy was provided . Muscle weakness and left hemiparesis were associated with less upper-limb activity . CONCLUSION These acute stroke care units were re source d according to recommended staff-patient ratios . Patients received little therapy and had low levels of physical activity Background and Purpose — One way that stroke units may improve outcome is by reducing complications of immobility through early mobilization ; however , this intervention needs testing . The purpose of this study was to determine the physical activity patterns of stroke patients managed within acute stroke units as a first step in developing an early mobilization protocol . Methods — We recruited 64 patients within 14 days after stroke from 5 metropolitan stroke units and observed them for 2 consecutive days at 10-minute intervals between the hours of 8 am and 5 pm . At each observation , we ascertained physical activity , location , and other person(s ) present . Therapists recorded therapy details . Results — The 58 patients who completed the study had a mean age of 71.3 years . Stroke severity ranged from mild ( National Institutes of Health Stroke Scale score , 1 ) to severe ( score , 27 ) , and mean time after stroke at observation was 5.6 days ( range , 0 to 13 days ) . Only 9 patients were restricted to bed . During the therapeutic day , patients spent > 50 % resting in bed , 28 % sitting out of bed , and only 13 % engaged in activities with the potential to prevent complications and improve recovery of mobility . Patients were alone > 60 % of the time . Conclusions — This is the first multicenter study of physical activity early after stroke . We believe the next step is to conduct a r and omized controlled trial to evaluate the effect of increased levels of  physical activity  early after stroke compared with current st and ards of care Background : Stroke patients are more likely to make a good recovery if they receive care in a well-organised stroke unit . However , there are uncertainties about how best to provide such care . We studied 2 key aspects of early stroke unit care : early active mobilisation ( EM ) and automated monitoring ( AM ) for physiological complications such as hypoxia . Methods : This was an observer-blinded , factorial ( 2 × 2 ) pilot r and omised controlled trial recruiting stroke patients within 36 h of symptom onset . The patients were  r and omised  to 1 of 4 nurse-led treatment protocol s : ( a ) st and ard stroke unit care , ( b ) EM , ( c ) AM or ( d ) combined EM and AM . The primary outcome was the Rankin score at 3 months . We also report the data on feasibility and safety . Results : We r and omised 32 patients ( mean age = 65 years ; mean baseline modified NIH score = 6 ) . On unadjusted comparisons , the EM patients were significantly ( p < 0.05 ) more likely to mobilise very early ( within 1 h of r and omisation ) and to achieve walking by day 5 and were less likely to develop complications of immobility . The AM group was significantly ( p < 0.05 ) more likely to have pre-defined physiological complication events detected . All these associations remained , but were less statistically significant , after correcting for age , baseline NIH score and co- interventions . There were no significant safety concerns . Discussion : We have demonstrated the feasibility of implementing EM and AM for physiological complications in a r and omised controlled trial . Larger trials are warranted to determine whether these interventions have clinical benefits Purpose . Commencing an early and active mobilisation programme in the acute stages of stroke may have important physical and psychological benefits that might improve long-term quality of life . We hypothesised that patients who received very early mobilisation ( VEM )  would experience better quality of life than those receiving st and ard care ( SC ) . Methods . The study was a Phase II single-blind r and omised controlled trial :  VEM patients received earlier ( within 24 h of stroke onset ) and more intensive physical therapy than SC patients for the first 14 days ( or until discharge ) . Quality of life was measured using the Assessment of Quality of Life ( AQoL ) question naire , administered face-to-face by a blinded assessor at 12 months post-stroke . Results . Seventy-one individuals with stroke ( VEM 38 , SC 33 ) were recruited . At follow-up , the median overall AQoL score was higher in VEM patients ( 0.32 ) than SC patients ( 0.24 ) . This group difference was not significant ( p = 0.17 ) , but it was significant at the 75th percentile ( p = 0.003 ) in favour of VEM . VEM patients also reported higher quality of life than SC patients in the physical function related ‘ Independent Living ’ domain of the AQoL ( p = 0.03 adjusted for age ; p = 0.04 adjusted for stroke severity ) . Conclusions . VEM may help improve long-term quality of life after stroke , particularly in relation to functional independence , but this requires further examination We design ed a 15-item neurologic examination stroke scale for use in acute stroke therapy trials . In a study of 24 stroke patients , interrater reliability for the scale was found to be high ( mean kappa = 0.69 ) , and test-retest reliability was also high ( mean kappa = 0.66 - 0.77 ) . Test-retest reliability did not differ significantly among a neurologist , a neurology house officer , a neurology nurse , or an emergency department nurse . The stroke scale validity was assessed by comparing the scale scores obtained prospect ively on 65 acute stroke patients to the patients ' infa rct ion size as measured by computed tomography scan at 1 week and to the patients ' clinical outcome as determined at 3 months . These correlations ( scale-lesion size r = 0.68 , scale- outcome r = 0.79 ) suggested acceptable examination and scale validity . Of the 15 test items , the most interrater reliable item ( pupillary response ) had low validity . Less reliable items such as upper or lower extremity motor function were more valid . We discuss methods for improving the reliability and validity of brief examination scales to be used in stroke therapy trials OBJECTIVE The immobility common to patients after acute stroke has the potential to increase negative mood symptoms . We evaluated the effect of very early mobilization after stroke on levels of depression , anxiety and irritability . DESIGN AVERT is a r and omized controlled trial ; patients in the very early mobilization group receive mobilization earlier ( within 24 h of stroke ) and more frequently than patients in the st and ard care group . PATIENTS Seventy-one patients with confirmed stroke were included . METHODS Patients were assessed on the Irritability , Depression and Anxiety ( IDA ) scale at multiple time-points . RESULTS At 7 days , very early mobilization patients were less depressed ( z=2.51 , p=0.012 ) and marginally less anxious ( z=1.79 , p=0.073 ) than st and ard care patients ( Mann-Whitney test ) . Classifying IDA scores as normal or depressed , and using backward stepwise multivariable logistic regression , very early mobilization was associated with a reduced likelihood of depression at 7 days ( odds ratio 0.14 , 95 % confidence interval 0.03 - 0.61 ; p=0.009 ) . CONCLUSION Very early mobilization may reduce depressive symptoms in stroke patients at 7 days post-stroke BACKGROUND AND PURPOSE We have previously shown that treatment of acute stroke patients in our stroke unit ( SU ) compared with treatment in general ward ( GWs )  improves short- and long-term survival and functional outcome and increases the possibility of earlier discharge to home . The aim of the present study was to identify the differences in treatment between the SU and the GW and to assess which aspects of the SU care which were most responsible for the better outcome . METHODS Of the 220 patients included in our trial , only 206 were actually treated ( SU , 102 patients ; GW , 104 patients ) . For these patients , we identified the differences in the treatment and the consequences of the treatment . We analyzed the factors that we were able to measure and their association with the outcome , discharge to home within 6 weeks . RESULTS Characteristic features in our SU were teamwork , staff education , functional training , and integrated physiotherapy and nursing . Other treatment factors significantly different in the SU from the GW were shorter time to start of the systematic mobilization/training and increased use of oxygen , heparin , intravenous saline solutions , and antipyretics . Consequences of the treatment seem to be less variation in diastolic and systolic blood pressure ( BP ) , avoiding the lowest diastolic BP , and lowering the levels of glucose and temperature in the SU group compared with the GW group . Univariate analyses showed that all these factors except the level of glucose were significantly associated with discharge to home within 6 weeks . In the final multivariate Cox regression model , shorter time to start of the mobilization/training and stabilized diastolic BP were independent factors significantly associated with discharge to home within 6 weeks . CONCLUSIONS Shorter time to start of mobilization/training was the most important factor associated with discharge to home , followed by stabilized diastolic BP , indicating that these factors probably were important in the SU treatment . The effects of characteristic features of an SU , such as a specially trained staff , teamwork , and involvement of relatives , were not possible to measure . Such factors might be more important than those actually measured Background and Purpose — Regaining functional independence is an important goal for people who have experienced stroke . We hypothesized that introducing earlier and more intensive out-of-bed activity after stroke would reduce time to unassisted walking and improve independence in activities of daily living . Methods — A Very Early Rehabilitation Trial ( AVERT 
    Output:
    
VEM , which usually involved first mobilisation within 24 hours of stroke onset , did not increase the number of people who survived or made a good recovery after their stroke .
VEM may have reduced the length of stay in hospital by about one day , but this was based on low- quality evidence .
Based on the potential hazards reported in the single largest RCT , the sensitivity analysis of trials commencing mobilisation within 24 hours , and the NMA , there was concern that VEM commencing within 24 hours may carry an increased risk , at least in some people with stroke .