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, November 27, 2019

Evaluation of an extended stroke rehabilitation service (EXTRAS): a multicentre randomized controlled trial

And why would you expect extended rehab to be effective?  If you want rehab to be more effective you are going to have to stop the 5 causes of the neuronal cascade of death in the first week. If my doctors had done that they would have saved me  5.4 billion neurons. Recovery would have been easy with only 171 million dead neurons.  Or you get neuroplasticity and neurogenesis to be repeatable on demand.  Not guidelines, PROTOCOLS. 

Evaluation of an extended stroke rehabilitation service (EXTRAS): a multicentre randomized controlled trial


Lookup NU author(s): Dr Lisa Shaw, Dr Richard Francis, Denise Howel, Dr Peter McMeekin, Dr Christopher Price, Elaine Stamp, Professor Luke Vale, Professor Helen Rodgers

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This is the authors' accepted manuscript of a conference proceedings (inc. abstract) that has been published in its final definitive form by Sage Publications Ltd, 2019.
For re-use rights please refer to the publisher's terms and conditions.

Abstract

Background: 
Stroke survivors frequently report unmet needs in the longer term but there is limited evidence to guide provision of ongoing rehabilitation.
Method:
This study was a randomized controlled trial involving 19 UK centres which provided early supported discharge (ESD). Adult stroke patients were individually randomized to receive extended stroke rehabilitation service (EXTRAS) or usual care (1:1). EXTRAS involved five rehabilitation reviews provided by an ESD team member between 1 and 18 months postESD. Reviews consisted of a semi-structured assessment of rehabilitation needs followed by goal-setting and action planning. The primary outcome was performance in extended activities of daily living (Nottingham Extended Activities of Daily Living (NEADL) scale) at 24months. Secondary outcomes included satisfaction with services, quality-adjusted life-year (QALYs) and costs. Analyses were ‘intention to treat’. Results/Findings:
A total of 573 participants were randomized (EXTRAS n=285, usual care n=288). Mean 24-month NEADL scores were EXTRAS 40.0 (SD 18.1) and usual care 37.2 (SD 18.5) giving an adjusted mean difference of 1.8 (95% confidence interval (CI) –0.7 to 4.2). At 24 months, patients in the intervention group were more satisfied with the services they received (97.7% vs. 87.5%, difference 10.2% (95% CI 5.3– 15.0)). EXTRAS provided more QALYs (0.07, 95% CI 0.01–0.12) and when combined with costs, there was a 90% chance of EXTRAS being costeffective at conventional thresholds of willingness to pay (£20,000 per QALY).
Conclusion:
EXTRAS did not improve stroke survivors’ performance in extended activities of daily living. However, due to the impact on costs and QALYs, EXTRAS has a high probability of being cost-effective at conventional thresholds of NHS willingness to pay.

Publication metadata

Author(s): Shaw L, Cant R, Drummond A, Ford GA, Forster A, Francis R, Hills K, Howel D, Laverty A, McKevitt C, McMeekin P, Price C, Stamp E, Stevens E, Vale L, Rodgers H
Publication type: Conference Proceedings (inc. Abstract)
Publication status: Published
Conference Name: The Society for Research in Rehabilitation Winter 2019 Meeting
Year of Conference: 2019
Pages: 1540–1556
Print publication date: 01/09/2019
Online publication date: 27/08/2019
Acceptance date: 01/07/2019
Date deposited: 21/11/2019
Publisher: Sage Publications Ltd
URL: https://doi.org/10.1177/0269215519843983
DOI: 10.1177/0269215519843983

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