Latest & greatest articles for stroke

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Top results for stroke

161. 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 NIHR DC | Signal - Carers of stroke survivors voice an unmet need for practical and emotional support Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Carers of stroke survivors voice an unmet need for practical and emotional support Published on 22 August 2017 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

NIHR Dissemination Centre2018

162. Group rehabilitation activities improve walking after stroke

Group rehabilitation activities improve walking after stroke NIHR DC | Signal - Group rehabilitation activities improve walking after stroke Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Group rehabilitation activities improve walking after stroke Published on 12 September 2017 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

NIHR Dissemination Centre2018

163. Mechanical clot removal for stroke reduces disability at two years

Mechanical clot removal for stroke reduces disability at two years NIHR DC | Signal - Mechanical clot removal for stroke reduces disability at two years Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Mechanical clot removal for stroke reduces disability at two years Published on 1 August 2017 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 (...) be delivered promptly. Public awareness of early 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. 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

NIHR Dissemination Centre2018

164. Supported self-management improves quality of life and self-belief after stroke

Supported self-management improves quality of life and self-belief after stroke NIHR DC | Signal - Supported self-management improves quality of life and self-belief after stroke Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Supported self-management improves quality of life and self-belief after stroke Published on 1 November 2016 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

NIHR Dissemination Centre2018

165. 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 NIHR DC | Signal - Exercise therapy may still improve balance when started a long time after a stroke Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Exercise therapy may still improve balance when started a long time after a stroke Published on 15 November 2016 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

NIHR Dissemination Centre2018

166. Intensive speech therapy helps stroke survivors with persistent communication difficulties

Intensive speech therapy helps stroke survivors with persistent communication difficulties NIHR DC | Signal - Intensive speech therapy helps stroke survivors with persistent communication difficulties Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Intensive speech therapy helps stroke survivors with persistent communication difficulties Published on 18 July 2017 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

NIHR Dissemination Centre2018

167. Giving oxygen routinely after a stroke does not improve outcomes

Giving oxygen routinely after a stroke does not improve outcomes NIHR DC | Signal - Giving oxygen routinely after a stroke does not improve outcomes Dissemination Centre Discover Portal NIHR DC Discover Giving oxygen routinely after a stroke does not improve outcomes Published on 3 January 2018 There was no benefit to routinely giving oxygen to people who have had a stroke. Oxygen given continuously, or just overnight, did not reduce disability or death and it did not improve people’s ability (...) to do everyday tasks or live independently. There were no oxygen-related adverse events reported. Strokes occur when the blood supply to the brain is disrupted by either a blocked or burst blood vessel. They can lead to death or disability as parts of the brain are deprived of blood. Therefore, giving oxygen to reduce the potential damage may appear to make sense. Guidelines from NICE and the British Thoracic Society recommend that people are not routinely given oxygen after a stroke unless

NIHR Dissemination Centre2018

168. Head position after acute stroke does not affect disability outcomes

Head position after acute stroke does not affect disability outcomes NIHR DC | Signal - Head position after acute stroke does not affect disability outcomes Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Head position after acute stroke does not affect disability outcomes Published on 3 October 2017 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

NIHR Dissemination Centre2018

169. Surgical clot removal within seven hours of stroke improves function

Surgical clot removal within seven hours of stroke improves function NIHR DC | Signal - Surgical clot removal within seven hours of stroke improves function Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Surgical clot removal within seven hours of stroke improves function Published on 13 December 2016 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

NIHR Dissemination Centre2018

170. Intermittent pressure on the legs helps prevent leg clots in immobile people after stroke

Intermittent pressure on the legs helps prevent leg clots in immobile people after stroke NIHR DC | Signal - Intermittent pressure on the legs helps prevent leg clots in immobile people after stroke Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Intermittent pressure on the legs helps prevent leg clots in immobile people after stroke Published on 1 December 2015 This NIHR-funded trial found that using intermittent pneumatic compression sleeves around the legs was effective (...) in preventing deep vein thrombosis in immobile people after a stroke. When used on people admitted within three days of an acute stroke, this technique was inexpensive and also appeared to improve survival at six months. The results of this study were used in the 2015 update to the 2010 NICE guideline about the care and treatment of people who are at risk of developing deep vein thrombosis while in hospital. Healthcare staff working in UK stroke units may require training in the use of intermittent

NIHR Dissemination Centre2018

171. Evidence is growing that early mechanical removal of clots from blocked brain arteries may improve recovery after stroke

Evidence is growing that early mechanical removal of clots from blocked brain arteries may improve recovery after stroke NIHR DC | Signal - Evidence is growing that early mechanical removal of clots from blocked brain arteries may improve recovery after stroke Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Evidence is growing that early mechanical removal of clots from blocked brain arteries may improve recovery after stroke Published on 17 December 2015 Restoring blood flow (...) to the brain within a few hours of having a stroke improves a person’s chances of recovery. Early use of drugs to dissolve clots (thrombolysis) has been the mainstay of management in recent years and there has also been rapid development of devices to remove clots. Using evidence from trials published in the last five years, this review found mechanical removal of clots was more effective than thrombolysis alone whereas earlier research of older techniques had suggested that mechanical removal was no more

NIHR Dissemination Centre2018

172. Centralising stroke services improves chances of patients getting the right care

Centralising stroke services improves chances of patients getting the right care NIHR DC | Signal - Centralising stroke services improves chances of patients getting the right care Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Centralising stroke services improves chances of patients getting the right care Published on 2 September 2015 This study of two models of organising stroke care showed that fully centralised services were more likely to deliver clinically effective (...) treatments. This NIHR-funded study looked at stroke care audit data before and after introducing two different models of centralised stroke services in London and Manchester. The audit recorded the proportion of stroke patients in each location who received each of seven effective care interventions, such as brain scans or clot-busting drugs within the recommended time. This study is one output from a large NIHR programme of research on the effects of stroke reconfiguration in London and Manchester

NIHR Dissemination Centre2018

173. Lowering blood pressure reduces the risk of heart disease, stroke and death

Lowering blood pressure reduces the risk of heart disease, stroke and death NIHR DC | Signal - Lowering blood pressure reduces the risk of heart disease, stroke and death Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Lowering blood pressure reduces the risk of heart disease, stroke and death Published on 23 February 2016 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 by 28%, and death from all causes by 13%. This study strongly supports offering drug treatments to reduce systolic blood pressure levels to less than 130 mm Hg to all people regardless of whether or not they have a history of cardiovascular disease, diabetes or chronic kidney disease. This evidence is likely to be considered by guideline developers. Why was this study needed? High blood pressure is one of the biggest risk factors for premature death

NIHR Dissemination Centre2018

174. Very early mobilisation following a stroke is no better than usual care

Very early mobilisation following a stroke is no better than usual care NIHR DC | Signal - Very early mobilisation following a stroke is no better than usual care Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Very early mobilisation following a stroke is no better than usual care Published on 22 April 2015 The AVERT trial found very early mobilisation - such as out-of-bed sitting, standing and walking - within 24 hours of stroke onset and at increased intensity, led to 4 (...) day after a stroke. Why was this study needed? Stroke is the fourth largest cause of death in the UK and the largest cause of complex disability. Each year in England, approximately 110,000 people have a first or recurrent stroke. More than 900,000 people in England are living with the effects of stroke, with half of these being dependent on other people for help with everyday activities. Early mobilisation – including sitting out-of-bed, standing and walking – is thought to improve outcomes after

NIHR Dissemination Centre2018

175. Occupational therapy several years after stroke does not improve function in severely ill care home residents

Occupational therapy several years after stroke does not improve function in severely ill care home residents NIHR DC | Signal - Occupational therapy several years after stroke does not improve function in severely ill care home residents Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Occupational therapy several years after stroke does not improve function in severely ill care home residents Published on 21 August 2015 This trial found that a three-month individualised (...) occupational therapy programme did not significantly improve the daily functioning (dressing, using the toilet and overall mobility) of severely physically and cognitively impaired people living in residential care who had a stroke on average three years before. About a quarter of stroke survivors in the UK cannot return home and need residential care. Occupational therapy is recommended immediately after a stroke for those likely to benefit. As occupational therapy did not help this severely disabled

NIHR Dissemination Centre2018

176. Self-management support for stroke survivors may improve independence

Self-management support for stroke survivors may improve independence NIHR DC | Signal - Self-management support for stroke survivors may improve independence Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Self-management support for stroke survivors may improve independence Published on 19 October 2015 This NIHR-funded summary of systematic reviews looked at the evidence on self-management support for stroke survivors. It found that the term self-management was rarely used (...) in the literature. There was high quality evidence that therapy-based rehabilitation, some of it including components supporting self-management, had a beneficial effect on the basic activities of daily living, such as feeding, bathing and dressing and extended activities, such as shopping. Self-management support is a less well established aspect of care for people after stroke, in contrast to its established role for other long-term conditions like diabetes. These researchers looked in detail

NIHR Dissemination Centre2018

177. Electrical stimulation alongside other treatments may slightly improve ankle spasticity after stroke, but the clinical importance is uncertain

Electrical stimulation alongside other treatments may slightly improve ankle spasticity after stroke, but the clinical importance is uncertain NIHR DC | Signal - Electrical stimulation alongside other treatments may slightly improve ankle spasticity after stroke, but the clinical importance is uncertain Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Electrical stimulation alongside other treatments may slightly improve ankle spasticity after stroke, but the clinical (...) importance is uncertain Published on 5 November 2015 This systematic review and meta-analysis found that electrical stimulation produced a small, but statistically significant improvement, in tight muscles (spasticity) for people recovering from stroke. The clinical importance of the improvement is uncertain. For example, electrical stimulation improved joint flexibility by an average of 2.87 degrees and spasticity improved by 0.3 on a 5 point scale. Stimulation was only found to work when used alongside

NIHR Dissemination Centre2018

178. Mechanical clot removal may offer better outcomes for people with stroke

Mechanical clot removal may offer better outcomes for people with stroke NIHR DC | Signal - Mechanical clot removal may offer better outcomes for people with stroke Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Mechanical clot removal may offer better outcomes for people with stroke Published on 28 June 2016 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 (...) . Mechanical clot removal is a highly skilled operation 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. 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

NIHR Dissemination Centre2018

179. Early aspirin reduces stroke recurrence following warning symptoms

Early aspirin reduces stroke recurrence following warning symptoms NIHR DC | Signal - Early aspirin reduces stroke recurrence following warning symptoms Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal Early aspirin reduces stroke recurrence following warning symptoms Published on 7 July 2016 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

NIHR Dissemination Centre2018

180. Adding a third antiplatelet drug after a stroke increases harms but not benefits

Adding a third antiplatelet drug after a stroke increases harms but not benefits NIHR DC | Signal - Adding a third antiplatelet drug after a stroke increases harms but not benefits Dissemination Centre Discover Portal NIHR DC Discover Adding a third antiplatelet drug after a stroke increases harms but not benefits Published on 27 March 2018 A combination of aspirin, clopidogrel and dipyridamole increases the risk of major bleeding. Taking all three drugs at the same time 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

NIHR Dissemination Centre2018