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Latest & greatest articles for stroke
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on stroke or other clinical topics then use Trip today.
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Mechanical clot removal for stroke reduces disability at two years Mechanical clot removal for stroke reduces disability at two years Discover Portal Discover Portal Mechanical clot removal for stroke reduces disability at two years Published on 1 August 2017 doi: Timely mechanical removal of the blood clots from inside vessels in the brain after a stroke reduces disability and improves quality of life at two years compared with usual care. Over a third of those in the thrombectomy group had (...) signs of stroke enables early medical attention. The procedure is currently planned for 24 specialist centres in England and will be available around the clock to facilitate urgent diagnosis and effective treatment. Share your views on the research. Why was this study needed? Stroke is the fourth leading cause of death in the UK and the leading cause of disability. There are over 100,000 strokes in the UK each year, costing the NHS in England around £1.7 billion. Eighty five per cent of strokes
Group rehabilitation activities improve walking after stroke Group rehabilitation activities improve walking after stroke Discover Portal Discover Portal Group rehabilitation activities improve walking after stroke Published on 12 September 2017 doi: Group-based circuit class therapy (CCT) focused on repetitive mobility, and functional tasks improved walking ability in people after stroke. People walked on average 61m further during six minutes than those receiving comparison interventions. CCT (...) involves stroke survivors practising different activities at workstations in sight of each other. This Cochrane review identified 17 trials of group-based CCT, given at least weekly for four weeks, compared with other physical therapies or no intervention. Those receiving CCT showed clinically meaningful improvements in walking distance and speed, as well as independence and balance. Regular multidisciplinary team rehabilitation is a central component of post-stroke care. However, there are no specific
Head position after acute stroke does not affect disability outcomes Head position after acute stroke does not affect disability outcomes Discover Portal Discover Portal Head position after acute stroke does not affect disability outcomes Published on 3 October 2017 doi: Lying flat for 24 hours after a stroke is no better than sitting up at an angle of at least 30 degrees. These differences in early head position did not affect people’s levels of disability or survival to 90 days, which (...) was more than 92% in both groups. It had been thought that the head down position might increase the chance of pneumonia, but in this trial, the rates were also similar for people cared for in either position. The results of this large international randomised controlled trial are likely to be applicable to adults with different types of stroke in varied settings. As lying position did not affect outcomes, this suggests that clinicians can be guided by patients’ clinical condition, preferences
Carers of stroke survivors voice an unmet need for practical and emotional support Carers of stroke survivors voice an unmet need for practical and emotional support Discover Portal Discover Portal Carers of stroke survivors voice an unmet need for practical and emotional support Published on 22 August 2017 doi: The carers of stroke survivors express a need to be recognised by hospital rehabilitation teams as partners in care. Carers emphasised that their deep knowledge can contribute to joint (...) decision making about the care of their spouse or family member. This research suggests that considering carers’ needs for support, information and training into care planning could ease the distress currently reported. This review describes how family, friends and spouses often felt emotionally overwhelmed, excluded from important discussions about the stroke survivor’s rehabilitation or unsupported in adapting to their caring role. The review included studies from ten diverse countries
Intensive speech therapy helps stroke survivors with persistent communication difficulties Intensive speech therapy helps stroke survivors with persistent communication difficulties Discover Portal Discover Portal Intensive speech therapy helps stroke survivors with persistent communication difficulties Published on 18 July 2017 doi: Intensive speech and language therapy begun six months or more after a stroke improved verbal communication, language comprehension and self-reported quality (...) of life for those with persistent communication difficulties (chronic aphasia). The therapy in this trial consisted of around 30 hours over three weeks. Participants who received low-intensity therapy (around one hour per week) whilst on a waiting list did not improve during that time. NICE guidelines recommend speech and language therapy immediately after a stroke and if the person still experiences communication difficulties six months after their stroke, but do not specify the intensity
Surgical clot removal within seven hours of stroke improves function Surgical clot removal within seven hours of stroke improves function Discover Portal Discover Portal Surgical clot removal within seven hours of stroke improves function Published on 13 December 2016 doi: For ischaemic stroke caused by a blood clot, early surgical clot removal alongside medical treatment improves functional outcomes at three months compared with medical treatment alone. Urgent stroke treatment is known (...) to improve outcomes. Endovascular thrombectomy is a relatively new technique to mechanically remove the clot, where this is possible. Uncertainty over the optimal timing of the procedure led to this review. This analysis of 1,287 patients in five trials found that endovascular thrombectomy improves outcomes only if performed within seven hours of initial stroke symptoms. The earlier that the clot was removed the better; the minimum “time to treatment” in the trials was 3 hours. Functional benefits
Repetitive task training can help recovery after stroke Repetitive task training can help recovery after stroke Discover Portal Discover Portal Repetitive task training can help recovery after stroke Published on 25 April 2017 doi: Following a stroke, people who received repetitive task training showed greater improvements in performing functional tasks, such as picking up a cup, standing up and walking. These improvements were sustained for up to six months. Disability following stroke (...) is common, affecting around half of all stroke survivors. This NIHR-funded review of over thirty trials found that repetitive task training provided small gains in arm and leg function, balance and walking distance (about 35 metres). We do not yet know the optimum number of sessions, or the ideal duration or intensity. However, it is a versatile and relatively easy intervention which can be delivered by physiotherapists/occupational therapists in groups, individually, in hospital, in the community
Better prescribing might prevent thousands of strokes in the UK Better prescribing might prevent thousands of strokes in the UK Discover Portal Discover Portal Better prescribing might prevent thousands of strokes in the UK Published on 3 May 2017 doi: One third of people who had a first stroke in the UK between 2009 and 2013 had known risk factors and were not taking the drugs that might have prevented their stroke. Electronic general practice records from almost 30,000 people who had a stroke (...) showed that about 60% had risk factors that meant they might have been eligible to take cholesterol-lowering, anti-clotting or blood pressure medication. But 54% of these people had no recent prescription for the appropriate drug(s). The researchers estimate that almost 12,000 strokes a year in the UK could be prevented if everyone eligible for preventive drugs took them. We don’t know the reasons why people weren’t prescribed these drugs. They might have had valid medical reasons for not taking them
Supported self-management improves quality of life and self-belief after stroke Supported self-management improves quality of life and self-belief after stroke Discover Portal Discover Portal Supported self-management improves quality of life and self-belief after stroke Published on 1 November 2016 doi: Training people to take an active role in managing the consequences of their stroke improves their quality of life. These self-management programmes are usually led by health professionals (...) . They cover a range of skills including problem solving, goal setting, and decision-making and provide advice about stroke. The improvement appears to act through “self-belief”. For example, promoting independence in people appeared to foster a greater belief in their own abilities. This Cochrane review pooled data from 14 trials comparing supported self-management with control interventions in people who had experienced a stroke one month to a year previously and lived in the community. Participants
Exercise therapy may still improve balance when started a long time after a stroke Exercise therapy may still improve balance when started a long time after a stroke Discover Portal Discover Portal Exercise therapy may still improve balance when started a long time after a stroke Published on 15 November 2016 doi: Exercise therapy may improve balance for people in the chronic phase of recovery six or more months after stroke. The most effective training regimens seem to be those that focus (...) on balance, weight shifting and gait training. Though significant, the improvements in function may still be small. Often little recovery can be expected beyond six months of stroke, and available treatments may be limited. This review found that exercise therapy in this population gave small improvements, generally in the scale of a few points on a scale of about 50, depending on the balance test used. This review included a large number of small trials, but most were high quality studies. They assessed
Adding a third antiplatelet drug after a stroke doesn’t reduce the risk of another stroke Adding a third antiplatelet drug after a stroke doesn’t reduce the risk of another stroke Discover Portal Discover Portal Adding a third antiplatelet drug after a stroke doesn’t reduce the risk of another stroke Published on 27 March 2018 doi: A combination of aspirin, clopidogrel and dipyridamole does not reduce the incidence or severity of recurrent stroke in people who have had a stroke or transient (...) ischaemic attack (TIA). This NIHR-funded trial compared the triple treatment to current guideline-based antiplatelet therapy for preventing further stroke or TIA (brief loss of blood supply to the brain). UK guidance recommends aspirin initially followed by clopidogrel alone as for most people this gives the best balance of effectiveness and bleeding risk. Dual therapy with aspirin and clopidogrel may be used for the first three months following ischaemic stroke or TIA in certain groups. The trial
Mechanical clot removal may offer better outcomes for people with stroke Mechanical clot removal may offer better outcomes for people with stroke Discover Portal Discover Portal Mechanical clot removal may offer better outcomes for people with stroke Published on 28 June 2016 doi: Mechanical clot removal alongside standard clot-busting drug treatment may offer better functional outcomes for people who have suffered a stroke caused by a blood clot than drug treatment alone. This review found (...) that should be performed within six to eight hours after the stroke. Patients would need early access to stroke units with the necessary diagnostics, technology and specialist expertise. Therefore a pragmatic NHS trial and cost-effectiveness analysis would be informative. Share your views on the research. Why was this study needed? Stroke is the UK’s third largest cause of death, after heart disease and cancer, and a major cause of adult disability. The health and social care costs of stroke in the UK
Early aspirin reduces stroke recurrence following warning symptoms Early aspirin reduces stroke recurrence following warning symptoms Discover Portal Discover Portal Early aspirin reduces stroke recurrence following warning symptoms Published on 7 July 2016 doi: Aspirin taken as soon as possible after a stroke or symptoms of a stroke reduces the risk of further stroke within the next six weeks by about 60%. This is much better than the 13% reduction previously estimated. People with warning (...) strokes, where symptoms resolve within 24 hours, stand to benefit by self-administering aspirin even before a scan can be organised. This analysis of 12 large randomised controlled trials compared outcomes for adults taking aspirin, other drugs that prevent blood clots and no treatment. Aspirin importantly and significantly reduced the risk of early recurrent stroke in people with warning strokes and strokes perceived as less severe. The results support current recommendations that aspirin should
Omega-3 supplements do not prevent heart disease, stroke or death Omega-3 supplements do not prevent heart disease, stroke or death Discover Portal Discover Portal Omega-3 supplements do not prevent heart disease, stroke or death Published on 6 November 2018 doi: Omega-3 fatty acid supplements from fish oils or plants have little or no effect on the risk of heart disease, stroke or overall death rates. This finding contradicts a widespread belief that omega-3 supplements are protective (...) , and it is possible that the intake of foods rich in omega-3 may have a place in a healthy balanced diet. Share your views on the research. Why was this study needed? Heart disease, stroke and arterial disease, all affect blood vessels. They account for one-third of deaths and, in 2010, cost NHS England £8 billion. There is a widespread belief that omega-3 can protect against heart disease and stroke, and capsules containing purified omega-3 are widely used. Three different types of omega-3 are metabolically
Two antiplatelet drugs may prevent further strokes but increase major bleeds Two antiplatelet drugs may prevent further strokes but increase major bleeds Discover Portal Discover Portal Two antiplatelet drugs may prevent further strokes but increase major bleeds Published on 2 October 2018 doi: People experiencing a minor stroke or a transient ischaemic attack have a lower risk of further stroke within 90 days if given clopidogrel and aspirin, rather than aspirin alone. However, taking both (...) drugs doubles the risk of bleeding over the same period. Current UK guidelines recommend using clopidogrel alone. In this major international trial of nearly 5,000 people, those who took the dual treatment had fewer heart attacks or strokes than those who took aspirin only, particularly in the first 30 days of treatment. Major bleeding risk was fairly constant on combined treatment throughout 90 days, occurring in 0.9% compared with 0.4% on aspirin. This study provides more evidence on the balance
Robot-assisted arm training after stroke helps people regain some strength and independence Stroke rehabilitation using robot-assisted arm training Discover Portal Discover Portal Robot-assisted arm training after stroke helps people regain some strength and independence Published on 11 December 2018 doi: People who have electromechanical or robot-assisted arm rehabilitation after stroke have better arm function and strength as well as finding it easier to complete activities of daily living (...) . Although moderate, the improvements suggest it may be worth considering these interventions as an adjunct to usual therapy. Many people have impaired arm function after a stroke and rehabilitation is often required. Robot-assisted arm training uses devices to support therapeutic movements. Feedback, given by the machines, allows the exercises to be tailored to the individual. Use can increase the intensity of therapy and improve motivation. The evidence for their use so far has not been strong
Impact and sustainability of centralising acute stroke services in English metropolitan areas: retrospective analysis of hospital episode statistics and stroke national audit data. To investigate whether further centralisation of acute stroke services in Greater Manchester in 2015 was associated with changes in outcomes and whether the effects of centralisation of acute stroke services in London in 2010 were sustained.Retrospective analyses of patient level data from the Hospital Episode (...) Statistics (HES) database linked to mortality data from the Office for National Statistics, and the Sentinel Stroke National Audit Programme (SSNAP).Acute stroke services in Greater Manchester and London, England.509 182 stroke patients in HES living in urban areas admitted between January 2008 and March 2016; 218 120 stroke patients in SSNAP between April 2013 and March 2016.Hub and spoke models for acute stroke care.Mortality at 90 days after hospital admission; length of acute hospital stay; treatment
Lowering blood pressure reduces the risk of heart disease, stroke and death Lowering blood pressure reduces the risk of heart disease, stroke and death Discover Portal Discover Portal Lowering blood pressure reduces the risk of heart disease, stroke and death Published on 23 February 2016 doi: This meta-analysis showed that a 10 mm Hg reduction of systolic blood pressure reduced the risk of major cardiovascular disease events by 20%, coronary heart disease by 17%, stroke by 27%, heart failure (...) were also hand searched to identify further relevant studies. The quality of the included studies was assessed: the majority of the studies (113) were judged to be of low risk of bias. What did it find? Every 10 mm Hg systolic blood pressure reduction reduced the risk of major cardiovascular events by 20% (relative risk [RR] 0.80, 95% confidence interval [CI] 0.77 to 0.83), coronary heart disease by 17% (RR 0.83, 95% CI 0.78 to 0.88), stroke by 27% (RR 0.73, 95% CI 0.68 to 0.77), heart failure
Effects of Physical Exercise Interventions on Dual-Task Gait Speed Following Stroke: A Systematic Review and Meta-Analysis To estimate the treatment effects of exercise and/or gait training interventions on dual-task walking in people with stroke. The secondary objective was to conduct subgroup analyses to compare the treatment effects of interventions involving dual-task training to those without any dual-task training.A systematic search of the literature was conducted in 6 databases (PubMed (...) , CINAHL, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and Physiotherapy Evidence Database) up to July 18, 2017.Randomized controlled trials (RCTs), nonrandomized controlled trials, or uncontrolled studies involving individuals with stroke and examining the effects of exercise and/or gait training interventions on dual-task gait speed.We extracted data on participant characteristics, intervention duration, frequency, and type; pre and post gait speed and secondary nongait
Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.A single-blinded, 2-sequence, 2-period, crossover-designed study.Rehabilitation clinics and participant's home environment.Individuals with disabilities poststroke.During each intervention