Deans' stroke musings: Biomarkers for Patient Selection Improve Stroke Rehabilitation Trial Efficiency

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

Biomarkers for Patient Selection Improve Stroke Rehabilitation Trial Efficiency

What the fuck, the goal is 100% recovery for ALL survivors. Cherry picking will not be tolerated. So the stroke medical world expects strokes to be consistent, ignoring the real world stroke out there.

Biomarkers for Patient Selection Improve Stroke Rehabilitation Trial Efficiency

Originally published1 Feb 2019https://doi.org/10.1161/str.50.suppl_1.114Stroke. 2019;50:A114

Abstract

There is high inter-individual variability in recovery after stroke, which reduces statistical power in rehabilitation trials. This could be addressed by using biomarkers for patient selection. Corticospinal tract function assessed with transcranial magnetic stimulation (TMS) is a candidate biomarker for trials aiming to improve upper-limb motor recovery. Patients in whom TMS can elicit motor evoked potentials (MEPs) have a functionally intact lateral corticospinal tract and better motor recovery. We used an existing data set to estimate the sample sizes required to detect rehabilitation benefits on upper-limb motor performance 90 days after stroke. Baseline clinical assessments were made and MEP status of the paretic upper-limb determined within 7 days post-stroke. Upper-limb Fugl-Meyer (UE-FM) and Action Research Arm Test (ARAT) scores were obtained 90 days after stroke. Analyses were carried out for the full sample, and repeated for the MEP+ subset. Population estimates of the UE-FM and ARAT scores 90 days post-stroke were used to calculate the sample sizes required to detect clinically meaningful treatment effects of 7 points on the UE-FM and ARAT scores. Baseline and 90-day assessments were completed by 207 patients (103 women, mean 70.6 SD 15.1 years). The full sample and MEP+ subset (n=177) had similar demographic and baseline clinical characteristics. The estimated required sample sizes to detect treatment effects for MEP+ patients were only 27-29% of those for the full sample of patients. The estimated percentage of patients who are MEP+ was 85.5% (95%CI 81.2%-89.9%). Biomarkers could be used to enrich samples for stroke rehabilitation trials. Selecting patients on the basis of MEP status reduces variance, thereby reducing required sample size by around 75% without significantly limiting the pool of participants. Using biomarkers for patient selection could markedly increase rehabilitation trial sensitivity and efficiency, with associated decreases in costs and time required for completion.