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[Correspondence] Could upright posture be harmful in the early stages of stroke? – Author’s reply

The AVERT trial1 delivered a surprising result; higher dose of out-of-bed activity soon after stroke (very early mobilisation) led to a less favourable outcome than lower dose, but still early, out-of-bed activity. This finding will prompt revision of current guidelines,2 which have increasingly recommended early mobilisation. Precisely what should be recommended, however, is less clear at this point. Usual care did not consist of prolonged bed rest; 623 (59%) of 1050 patients in the usual care group started out-of-bed activity within 24 h of stroke onset, 525 (50%) patients had little or no disability (modified Rankin scale 0–2) at 3 months, and complication rates were low.