Scientists from The Florey are among the world's leading stroke
experts who have mapped out how researchers and clinicians can improve
outcomes for people who have survived a stroke.
The third Stroke
Recovery and Rehabilitation Roundtable, an initiative of the
International Stroke Recovery and Rehabilitation Alliance, has made a
series of key recommendations about managing fatigue, measuring
mobility, harnessing non-invasive brain stimulation technologies and
improving how trials are designed. The highly influential gathering of
world stroke experts published their findings in a special edition of International Journal of Stroke.
Associate
Professor Kate Hayward from The Florey and University of Melbourne in
Australia, co-chaired and convened the current roundtable, which was
established by fellow Florey stroke expert Professor Julie Bernhardt in
2016.
"The roundtables aim to address gaps that are hampering
progress across the field of stroke recovery and rehabilitation.
Momentum is gathering in stroke recovery and it's so important that we
work together, pulling in the right direction, for the benefit of the
millions of people globally who are affected by stroke," Associate
Professor Hayward said.
"Post-stroke fatigue, for instance, is
common and complex, yet very little is known about it. To address this,
an expert panel of researchers and people living with stroke sought to
define fatigue, create a roadmap for future research and design a new
fatigue assessment tool," she said.
The
Florey's Professor Julie Bernhardt said the roundtable's
recommendations are essential reading for clinicians and researchers in
the field of stroke recovery and rehabilitation.
"It
is through these collective actions that we can accelerate progress
towards effective treatments that enhance the lives of the millions of
people affected by stroke each year.
"The vision of our International Stroke Recovery and Rehabilitation
Alliance is a world where global collaboration leads to major
breakthroughs for people with stroke. Consensus building with these
international taskforce recommendations is having impact and are an
essential part of us achieving our vision," Professor Bernhardt said.
Fatigue after stroke
The
fatigue panel, led by University of Newcastle Professor Coralie English
and University of Edinburgh Professor Gillian Mead, noted that fatigue
affects almost half of all people living with stroke, yet there are no
clear recommendations for preventing, recognising, treating or managing
it.
The taskforce defined post-stroke fatigue as "a feeling of
exhaustion, weariness or lack of energy that can be overwhelming, and
which can involve physical, emotional, cognitive and perceptual
contributors, which is not relieved by rest and affects a person's daily
life."
They recommended that everyone who has had a stroke be
assessed using a new Stroke Fatigue Clinical Assessment Tool, which asks
a series of questions to ensure that fatigue isn't missed, and to draw
attention to potentially modifiable factors. Questions include whether
the patient:
- feels tired all the time
- feels sad, depressed, anxious or stressed
- has trouble sleeping
- lacks exercise or misses meals
- has trouble remembering or concentrating
- feels fatigued after talking or listening to others talk.
The panel recommended future research investigates psycho-education
interventions such as cognitive behavioural therapy, exercise,
anti-depressants and neuromodulation therapies.
Fatigue taskforce
co-lead, Professor English, said: "For many people living with stroke,
fatigue is their number one issue. For too long this area of stroke
recovery has been neglected in research. We hope our paper will inspire
researchers to work in this area and motivate breakthroughs that will
improve the lives of people living with post-stroke fatigue."
Non-invasive brain stimulation and stroke
A
second panel, led by University of Ottawa's Associate Professor Jodi
Edwards and University of Montreal's Professor Numa Dancause, focused on
finding ways to eliminate barriers for the use of non-invasive brain
stimulation technologies as a treatment for stroke rehabilitation. The
expert panel found that there is experimental and clinical evidence
supporting such technologies as safe and potentially effective adjuncts
to therapy post-stroke, yet their use is largely limited to treating
major depression and pain.
Brain stimulation taskforce co-lead,
Associate Professor Edwards, said: "Our panel sought to identify missing
evidence for how to optimise these technologies for use as a standard
treatment in post-stroke care. Surprisingly, we found that in addition
to evidence gaps, there were major limitations with existing trials.
This means as a field we are much farther from having the evidence
necessary to optimize these technologies than initially thought. We
propose a set of core recommendations and put forward a new checklist (You blithering idiots need to create an exact stroke protocol on this. Checklists DO NOTHING!)
for future studies and clinical trials to help advance the field of
brain stimulation post-stroke towards a pathway for translation to the
clinic."
Mobility and stroke
A
third panel, led by Amsterdam University Medical Centre's Professor
Gert Kwakkel and KU Leuven's Professor Geert Verheyden, recommended ways
researchers can improve data on post-stroke mobility, a key priority
for stroke survivors. The mobility panel said it was essential for
researchers to use standardised instruments to enable data from
different projects to be compared. The members also agreed on metrics,
definitions and instruments that researchers should use to measure
aspects of mobility including balance, walking independence and walking
endurance.
Mobility taskforce co-lead, Professor Kwakkel, said:
"Mobility problems are experienced by 80 per cent of stroke survivors
and often the most important goal for many post-stroke as it affects
their independence and quality of life. However, mobility is a complex
construct that encompasses different domains that require different
measurement instruments to assess recovery. In this panel, we achieved
consensus on how and when to measure balance and mobility problems of
people included in stroke recovery and rehabilitation studies."
Research trials for stroke
The
fourth roundtable, led by Associate Professor Hayward and Washington
University Professor Catherine Lang, focused on trial design,
specifically the control comparator group used in preclinical and
clinical trials of stroke recovery interventions. This panel developed
the CONtrol DeSIGN (CONSIGN) decision support tool to address challenges
identified and enhance control comparator selection, description, and
reporting.
Associate
Professor Hayward, said: "Identifying an appropriate type of control to
use in a preclinical or clinical trial is challenging, yet critically
important. The benefit of an experimental intervention is established
relative to a pre-specified control, and poor selection can reduce the
ability to demonstrate a difference between the two."
Scientists
from The Florey are among the world's leading stroke experts who have
mapped out how researchers and clinicians can improve outcomes for
people who have survived a stroke.
The third Stroke Recovery and
Rehabilitation Roundtable, an initiative of the International Stroke
Recovery and Rehabilitation Alliance, has made a series of key
recommendations about managing fatigue, measuring mobility, harnessing
non-invasive brain stimulation technologies and improving how trials are
designed. The highly influential gathering of world stroke experts
published their findings in a special edition of International Journal of Stroke.
Associate
Professor Kate Hayward from The Florey and University of Melbourne in
Australia, co-chaired and convened the current roundtable, which was
established by fellow Florey stroke expert Professor Julie Bernhardt in
2016.
"The roundtables aim to address gaps that are hampering
progress across the field of stroke recovery and rehabilitation.
Momentum is gathering in stroke recovery and it's so important that we
work together, pulling in the right direction, for the benefit of the
millions of people globally who are affected by stroke," Associate
Professor Hayward said.
"Post-stroke
fatigue, for instance, is common and complex, yet very little is known
about it. To address this, an expert panel of researchers and people
living with stroke sought to define fatigue, create a roadmap for future
research and design a new fatigue assessment tool," she said.
The
Florey's Professor Julie Bernhardt said the roundtable's
recommendations are essential reading for clinicians and researchers in
the field of stroke recovery and rehabilitation.
"It
is through these collective actions that we can accelerate progress
towards effective treatments that enhance the lives of the millions of
people affected by stroke each year.
"The vision of our International Stroke Recovery and Rehabilitation
Alliance is a world where global collaboration leads to major
breakthroughs for people with stroke. Consensus building with these
international taskforce recommendations is having impact and are an
essential part of us achieving our vision," Professor Bernhardt said.
Fatigue after stroke
The
fatigue panel, led by University of Newcastle Professor Coralie English
and University of Edinburgh Professor Gillian Mead, noted that fatigue
affects almost half of all people living with stroke, yet there are no
clear recommendations for preventing, recognising, treating or managing
it.(And I don't see you solving this problem! You're fired!)
The taskforce defined post-stroke fatigue as "a feeling of
exhaustion, weariness or lack of energy that can be overwhelming, and
which can involve physical, emotional, cognitive and perceptual
contributors, which is not relieved by rest and affects a person's daily
life."
They
recommended that everyone who has had a stroke be assessed using a new
Stroke Fatigue Clinical Assessment Tool, which asks a series of
questions to ensure that fatigue isn't missed, and to draw attention to
potentially modifiable factors. Questions include whether the patient:
- feels tired all the time
- feels sad, depressed, anxious or stressed
- has trouble sleeping
- lacks exercise or misses meals
- has trouble remembering or concentrating
- feels fatigued after talking or listening to others talk.
The panel recommended future research investigates psycho-education
interventions such as cognitive behavioural therapy, exercise,
anti-depressants and neuromodulation therapies.
Fatigue taskforce
co-lead, Professor English, said: "For many people living with stroke,
fatigue is their number one issue. For too long this area of stroke
recovery has been neglected in research. We hope our paper will inspire
researchers to work in this area and motivate breakthroughs that will
improve the lives of people living with post-stroke fatigue."
Non-invasive brain stimulation and stroke
A
second panel, led by University of Ottawa's Associate Professor Jodi
Edwards and University of Montreal's Professor Numa Dancause, focused on
finding ways to eliminate barriers for the use of non-invasive brain
stimulation technologies as a treatment for stroke rehabilitation. The
expert panel found that there is experimental and clinical evidence
supporting such technologies as safe and potentially effective adjuncts
to therapy post-stroke, yet their use is largely limited to treating
major depression and pain.
Brain stimulation taskforce co-lead,
Associate Professor Edwards, said: "Our panel sought to identify missing
evidence for how to optimise these technologies for use as a standard
treatment in post-stroke care. Surprisingly, we found that in addition
to evidence gaps, there were major limitations with existing trials.
This means as a field we are much farther from having the evidence
necessary to optimize these technologies than initially thought. We
propose a set of core recommendations and put forward a new checklist
for future studies and clinical trials to help advance the field of
brain stimulation post-stroke towards a pathway for translation to the
clinic."
Mobility and stroke
A
third panel, led by Amsterdam University Medical Centre's Professor
Gert Kwakkel and KU Leuven's Professor Geert Verheyden, recommended ways
researchers can improve data on post-stroke mobility, a key priority
for stroke survivors. The mobility panel said it was essential for
researchers to use standardised instruments to enable data from
different projects to be compared. The members also agreed on metrics,
definitions and instruments that researchers should use to measure
aspects of mobility including balance, walking independence and walking
endurance.
Mobility taskforce co-lead, Professor Kwakkel, said:
"Mobility problems are experienced by 80 per cent of stroke survivors
and often the most important goal for many post-stroke as it affects
their independence and quality of life. However, mobility is a complex
construct that encompasses different domains that require different
measurement instruments to assess recovery. In this panel, we achieved
consensus on how and when to measure balance and mobility problems of
people included in stroke recovery and rehabilitation studies."
Research trials for stroke
The
fourth roundtable, led by Associate Professor Hayward and Washington
University Professor Catherine Lang, focused on trial design,
specifically the control comparator group used in preclinical and
clinical trials of stroke recovery interventions. This panel developed
the CONtrol DeSIGN (CONSIGN) decision support tool to address challenges
identified and enhance control comparator selection, description, and
reporting.
Associate Professor Hayward, said: "Identifying an
appropriate type of control to use in a preclinical or clinical trial is
challenging, yet critically important. The benefit of an experimental
intervention is established relative to a pre-specified control, and
poor selection can reduce the ability to demonstrate a difference
between the two."
/Public Release. This material from the originating
organization/author(s) might be of the point-in-time nature, and edited
for clarity, style and length. Mirage.News does not take institutional
positions or sides, and all views, positions, and conclusions expressed
herein are solely those of the author(s).View in full
here.
