Clinical stroke research in resource limited settings: Tips and hints

 Except you don't even have the correct goal of 100% recovery  which means all the research you are suggesting is a waste of time. 

Clinical stroke research in resource limited settings: Tips and hints

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Jeyaraj D Pandian, Hueiming Liu, Dorcas BC Gandhi, ...

First Published November 17, 2017 Review Article Find in PubMed 

https://doi.org/10.1177/1747493017743798

Article information

  

Abstract

Background

Most stroke research is conducted in high income countries, yet most stroke occurs in low- and middle-income countries. There is an urgent need to build stroke research capacity in low- and middle-income countries.

Aims

To review the global health literature on how to improve research capacity in low- and middle-income countries, provide additional data from the recently completed ATTEND Trial and provide examples from our own experience.

Summary of review

The main themes from our literature review were: manpower and workload, research training, research question and methodology and research funding. The literature and our own experience emphasized the importance of local stakeholders to ensure that the research was appropriate, that there were robust local ethics and regulatory processes, and research was conducted by trained personnel. Research training opportunities can be developed locally, or internationally, with many international schemes available to help support new researchers from low- and middle-income country settings. International collaboration can successfully leverage funding from high income countries that not only generate data for the local country, but also provide new data appropriate to high income countries.

Conclusions

Building stroke research capacity in low- and middle-income countries will be vital in improving global health given the huge burden of stroke in these countries.

Keywords Low-income countries, ethics, funding, training, India, Asia, stroke, research

Introduction

In this second paper of a five-paper series on how to do good quality clinical research, we will discuss research in limited resource settings. The Global Burden of Disease investigators estimated that 70% of incident stroke and stroke deaths, half of all prevalent strokes and nearly 80% of DALYs lost were in low- and middle-income countries (LMICs), yet most research is done in high-income countries.¹ However, LMICs have only about 3% equivalent purchasing power to fund this demand.² Furthermore, it has been estimated that 90% of medical research is targeted on the health needs of the richest 10% of the world.³¹As stroke is occurring at an earlier age in LMICs, there is a disproportionate loss of DALYs in these countries. This has major implications for families, as those with stroke are often the breadwinners of the family, and thus stroke commonly leads to catastrophic financial hardship.⁴ The resulting mismatch between burden and research has led to large evidence practice gaps in global health.⁵ In addition, there is the inevitable tension in LMICs between cost effective public health strategies to reduce the burden of stroke (such as the identification and treatment of hypertension and stroke unit care), and the attraction of implementing the current “state of the art” stroke interventions, such as thrombectomy. There is a risk that piecemeal implementation of aspects of western medicine could consume all the available stroke resources, for very little public health benefit.

High-quality research is needed in LMICs to determine which local solutions work, and what is their cost-effectiveness. In this review article, we will discuss the barriers and facilitators of conducting clinical research, provide examples from our own experience, review the literature in this area and provide some new data from our recently completed stroke rehabilitation trial in India.

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