Deans' stroke musings: Assessing the Concordance Between Stroke Rehabilitation Research Participants & 'Real World'Stoke Patients

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, February 6, 2019

Assessing the Concordance Between Stroke Rehabilitation Research Participants & 'Real World'Stoke Patients

This is a major problem, cherry picking patients for clinical trials. So until they start actually using real world data, IT IS YOUR RESPONSIBILITY TO HAVE PERFECT STROKES AND PERFECT HEALTH.

Assessing the Concordance Between Stroke Rehabilitation Research Participants & 'Real World'Stoke Patients

Michelle Nelson

Originally published1 Feb 2019https://doi.org/10.1161/str.50.suppl_1.115Stroke. 2019;50:A115

Abstract

Stroke rehabilitation programs have been transformed to better align with stroke Clinical Practice Guidelines (CPGs), which prioritize randomized control trials as evidence-based best practices. However, a recent review of stroke rehabilitation randomized control trials (RCTs) found that the RCTS tended to include younger participants, excluded participants based on age related criteria, and often excluded individuals with comorbidities. The objective of this study was to determine the proportion of stroke patients that would meet the enrolment criteria of stroke rehabilitation randomized controlled trials. A retrospective chart audit was conducted for all patients discharged from a high intensity stroke rehabilitation unit for a one-year period (n=110). RCT exclusion criteria were extracted from a recent review that analyzed the study inclusion and exclusions of 428 RCTs (age, cognitive impairment, previous stroke, and comorbidities). These study exclusions were applied to the 110 patients to determine how many patients would have been eligible to participate in the RCTs. Patients admitted to the stroke rehab unit had a mean age of 67.4 years and an average of 6.2 co-morbidities. 60.1% of these patients would have been excluded from participating in the RCTs by one or more exclusion criteria. 5.5% of patients would have been excluded based on age, 84.5% of patients would have been ineligible for 54% of RCTs based on cognitive impairment, 28% of patients would have been ineligible for 36% of RCTs based on a previous stroke, and 4.2% of patients would have been excluded based on the presence of a CCI condition or stroke risk factor. Results highlight the difference between trial subjects and ‘real world’ patients. Based on our understanding of how people accumulate chronic conditions with age, it can be inferred that the high quality evidence may not reflect the clinical reality of stroke rehabilitation. Given the high prevalence of increased age and comorbidities among stroke rehabilitation patients, this study emphasizes the importance of including ‘typical stroke patients’ in research studies or supporting the use of alternative methodologies that addresses application of study results to older patients with comorbidities.