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Latest & greatest articles for stroke
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are eligible to receive continual long-term community-based physiotherapy have already received 12 weeks of physiotherapy after being diagnosed with stroke. We excluded people who were admitted to hospital for transientischemicattack, as it is characterized as a minor and nondisabling type of stroke, 16 and focused on people who were admitted for either ischemic or (intracerebral or subarachnoid) hemorrhagic stroke. Budget Impact Analysis March 2020 Ontario Health Technology Assessment Series; Vol. 20 (...) and long-term medical attention. There are different types of stroke. The two major classifications are ischemicstroke and hemorrhagic stroke. Ischemicstroke occurs when an artery in the brain is blocked. Hemorrhagic stroke occurs when a blood vessel in the brain breaks open, interrupting blood flow in the brain. 1 Clinical Need and Target Population In Canada, approximately 62,000 people suffer a stroke annually, and about 405,000 are living with the consequences of a stroke. 2 This number
be costly, or forgo super- vised therapy and potentially not meet their rehabilita- tion and recovery potential. The 2019 update of the Canadian Stroke Best Practice Recommendations (CSBPR): Rehabilitation and Recovery following Stroke module is a comprehen- sive summary of current evidence-based recommenda- tions, focusing primarily on the management of people who have already had a moderately or severely dis- abling stroke. People with milder stroke or transientischemicattack may not require (...) for select patients with acute stroke (for instance, people with more mild strokesor transientischemicattack) butcautionisadvised, andclinical judgmentshouldbeused(Evidence Level C). (iv) Once deemed to be medically and neurologically stable, patients should receive a recommended three hours perdayof directtask-specific therapy, five days aweek, delivered by the interdisciplinary stroke team (Evidence Level C); more therapy results in better outcomes (Evidence Level A). (v) Individualized
compared with women: odds ratio (OR) 1.50, 95% confidence interval (CI) 1.08 to 2.08, p=0.015 7 . SHTG Advice | 10 In a large population-based cohort study in Oxfordshire (OXVASC), consecutive patients with a first transientischaemicattack (TIA) or ischaemicstroke were followed up for a period of 10 years 14 . Of 2,555 patients with a first ischaemic event, 32% were classed as cryptogenic. Incidence of cryptogenic ischaemicstroke in the OXVASC cohort was 0.36 per 1,000 population per year (95% CI (...) stroke or TIA has been indicated on clinical assessment and brain imaging. ? There is no significant atrial fibrillation requiring oral anticoagulant therapy. ? A full investigation has failed to identify known risk factors/explanations for the ischaemicstroke or TIA, such as vascular disease or hypertension. ? The presence of a PFO with a clinically significant right-to-left shunt or atrial septal aneurysm has been confirmed using bubble contrast transthoracic echocardiography, including
Brussel (control) with standard emergency care complemented with in-ambulance teleconsultation service by stroke experts (PreSSUB).The primary efficacy endpoint is the call-to-brain imaging time. Secondary endpoints for the efficacy analysis include the prevalence of medical events diagnosed and corrected during in-ambulance teleconsultation, the proportion of patients with ischemicstroke receiving recanalization therapy, the assessment of disability, functional status, quality of life and overall (...) PreSSUB II: The prehospital stroke study at the Universitair Ziekenhuis Brussel II. Stroke is a time-critical medical emergency requiring specialized treatment. Prehospital delay contributes significantly to delayed or missed treatment opportunities. In-ambulance telemedicine can bring stroke expertise to the prehospital arena and facilitate this complex diagnostic and therapeutic process.This study evaluates the efficacy, safety, feasibility, reliability and cost-effectiveness of in-ambulance
Feasibility and preliminary effects of an integrated hospital-to-home transitional care intervention for older adults with stroke and multimorbidity: A study protocol. Stroke is a major life-altering event and the leading cause of death and disability in Canada. Most older adults who have suffered a stroke will return home and require ongoing rehabilitation in the community. Transitioning from hospital to home is reportedly very stressful and challenging, particularly if stroke survivors have (...) adults (≥55 years) with a confirmed stroke diagnosis, ≥2 co-morbid conditions, and referred to a hospital-based outpatient stroke rehabilitation centre. The 6-month transitional care intervention will be delivered by an interprofessional (IP) team and involve care coordination/system navigation, self-management education and support, home visits, telephone contacts, IP team meetings and a web-based app. Primary evaluation of the intervention will be based on feasibility outcomes (e.g. acceptability
Guidelines for the Early Management of Patients With Acute IschemicStroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute IschemicStroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Background and Purpose- The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations in a single document for clinicians caring for adult patients with acute arterial ischemicstroke. The intended audiences (...) are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 Acute IschemicStroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines. Methods- Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Members were not allowed to participate in discussions or to vote on topics relevant
Essen Risk Score in Prediction of Myocardial Infarction After TransientIschemicAttack or IschemicStroke Without Prior Coronary Artery Disease Background and Purpose- More intensive secondary prevention with newer drugs may be cost-effective in patients with coronary artery disease (CAD). Whether some subgroups of patients who had a transientischemicattack (TIA) or ischemicstroke, but no prior CAD are at similar high risk of myocardial infarction as those with prior CAD remains unclear. We (...) determined whether the Essen score identified a subset of TIA/stroke patients without known prior CAD who, nevertheless, had a high risk of myocardial infarction on current secondary prevention management. Methods- In a population-based cohort (Oxford Vascular Study) of consecutive TIA or ischemicstroke patients recruited from 2002 to 2014, 10-year actuarial risks of myocardial infarction and of recurrent ischemicstroke were determined by face-to-face follow-up in patients with and without prior CAD
Training for Walking Efficiency With a Wearable Hip-Assist Robot in Patients With Stroke: A Pilot Randomized Controlled Trial Background and Purpose- The purpose of this study was to investigate the effects of gait training with a newly developed wearable hip-assist robot on locomotor function and efficiency in patients with chronic stroke. Methods- Twenty-eight patients with stroke with hemiparesis were initially enrolled, and 26 patients completed the randomized controlled trial (14 (...) parameters (P<0.05). Cardiopulmonary metabolic efficiency was strongly correlated with gait symmetry ratio in the experimental group (P<0.01). Conclusions- Gait training with Gait Enhancing and Motivating System was effective for improving locomotor function and cardiopulmonary metabolic energy efficiency during walking in patients with stroke. These findings suggest that robotic locomotor training can be adopted for rehabilitation of patients with stroke with gait disorders. Clinical Trial Registration
databases (MEDLINE, EMBASE, and Cochrane) for review. The primary outcome was recurrent stroke comprising ischemic and hemorrhagic stroke. Secondary outcomes included ischemicstroke, hemorrhagic stroke, myocardial infarction, and composite outcomes. We performed an updated systematic review and meta-analysis of the identified reports, including 2 recently published randomized controlled trials. In addition, network meta-analysis was performed to compare the relative effects of mono versus combination (...) . The cilostazol mono treatment diminished hemorrhagic stroke more significantly than SAPT and the cilostazol combination did not increase hemorrhagic stroke compared to SAPT. The outcomes from the 2 cilostazol regimens were comparable to SAPT in the case of myocardial infarction. Conclusions- Cilostazol is a more effective and safer treatment option than SAPT approaches using mainly aspirin. Cilostazol regimens can also be modified to clinical situations as this drug reduces recurrent and ischemicstroke more
A support programme for secondary prevention in patients with transientischaemicattack and minor stroke (INSPiRE-TMS): an open-label, randomised controlled trial Patients with recent stroke or transientischaemicattack are at high risk for a further vascular event, possibly leading to permanent disability or death. Although evidence-based treatments for secondary prevention are available, many patients do not achieve recommended behavioural modifications and pharmaceutical prevention targets (...) in the long-term. We aimed to investigate whether a support programme for enhanced secondary prevention can reduce the frequency of recurrent vascular events.INSPiRE-TMS was an open-label, multicentre, international randomised controlled trial done at seven German hospitals with acute stroke units and a Danish stroke centre. Patients with non-disabling stroke or transientischaemicattack within 2 weeks from study enrolment and at least one modifiable risk factor (ie, arterial hypertension, diabetes
Evaluating the effectiveness of aquatic therapy on mobility, balance, and level of functional independence in stroke rehabilitation: a systematic review and meta-analysis To meta-analyze and systematically review the effectiveness of aquatic therapy in improving mobility, balance, and functional independence after stroke.Articles published in Medline, Embase, CINAHL, PsycINFO, and Scopus up to 20 August 2019.Studies met the following inclusion criteria: (1) English, (2) adult stroke population
stroke registries. We performed multivariable Cox regression analysis to identify predictors of stroke recurrence. Based on the coefficient of each covariate of the fitted multivariable model, we generated an integer-based point scoring system. We validated the score externally assessing its discrimination and calibration.In 3 registries (884 patients) that were used as the derivation cohort, age, leukoaraiosis, and multiterritorial infarct were identified as independent predictors of stroke (...) recurrence and were included in the final score, which assigns 1 point per every decade after 35 years of age, 2 points for leukoaraiosis, and 3 points for multiterritorial infarcts (acute or old nonlacunar). The rate of stroke recurrence was 2.1 per 100 patient-years (95% confidence interval [CI] 1.44-3.06) in patients with a score of 0-4 (low risk), 3.74 (95% CI 2.77-5.04) in patients with a score of 5-6 (intermediate risk), and 8.23 (95% CI 5.99-11.3) in patients with a score of 7-12 (high risk
in Patients with Stroke and TransientIschemicAttack  Abbreviations: AHA: American Heart Association; ASA: American Stroke Association Sidebar 2: Assessment of Impairments and Disabilities ? Assessment of impairments • Auditory/hearing • Bowel and bladder function • Cognition • Communication • Emotion and behavior • Inattention/neglect • Motor/mobility • Swallowing and nutrition • Tactile/touch • Vision function and formal visual field ? Assessment of barriers to participation in therapy • Cognitive (...) in the form of medical, surgical, or rehabilitation interventions is essential to help reduce disability severity, decrease the risk of further complications, and lessen potentially life-long deficits.[5,6] Unfortunately, in approximately 30% of ischemicstroke cases, the cause of the stroke remains unknown. Ischemicstrokes with no obvious cause are labelled as “cryptogenic” strokes and are more common in younger patients than in the elderly. This is largely due to the lack of comorbidities
Postoperative Atrial Fibrillation Following Noncardiac Surgery Increases Risk of Stroke New-onset postoperative atrial fibrillation is well recognized to be an adverse prognostic marker in patients undergoing noncardiac surgery. Whether postoperative atrial fibrillation confers an increased risk of stroke remains unclear.A systematic review and meta-analysis was performed to assess the risk of stroke after postoperative atrial fibrillation in noncardiac surgery. MEDLINE, Cochrane, and EMBASE (...) databases were searched for articles published up to May 2019 for studies of patients undergoing noncardiac surgery that reported incidence of new atrial fibrillation and stroke. Event rates from individual studies were pooled and risk ratios (RR) were pooled using a random-effects model.Fourteen studies of 3,536,291 patients undergoing noncardiac surgery were included in the quantitative analysis (mean follow-up 1.4 ± 1 year). New atrial fibrillation occurred in 26,046 (0.74%), patients with a higher