What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

The evidence is appalling that stroke therapy only gets 10% to full recovery. THAT BY ANY DEFINITION IS COMPLETE AND TOTAL FAILURE! Only by using the tyranny of low expectations can  the stroke medical world  claim any modicum of success. I'd fire everyone involved in stroke for not even attempting to get to 100% recovery. All this biomarkers and predicting failure to recover is totally fucking useless to get survivors recovered.

YOU need to get involved, you can't leave this up to stroke medical 'professionals', they came up with the inadequate Helsingborg declarations.

Helsingborg 1996

Helsingborg 2006

What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

 
What Is the Evidence for Physical Therapy Poststroke? ASystematic Review and Meta-Analysis
Janne Marieke Veerbeek
1
, Erwin van Wegen
1
, Roland van Peppen
2
, Philip Jan van der Wees
3
,Erik Hendriks
4
, Marc Rietberg
1
, Gert Kwakkel
1,5
*
1
Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands,
 2
Department of Physiotherapy, University of Applied Sciences Utrecht, Utrecht, The Netherlands,
 3
Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud UniversityNijmegen Medical Center, Nijmegen, The Netherlands,
 4
Department of Epidemiology, Maastricht University, Maastricht, The Netherlands,
 5
Department of Neurorehabilitation, Reade Center for Rehabilitation and Rheumatology, Amsterdam, The Netherlands

Abstract

Background:
 

Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of thissystematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT.
Methods and Findings:
 

 Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through asystematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed.Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed forneurological treatment approaches. The search yielded 467 RCTs (N=25373; median PEDro score 6 [IQR 5–7]), identifying 53interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions forphysical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03–0.70; I2=0%) for therapeutic positioning of theparetic arm to 2.47 (95%CI 0.84–4.11; I2=77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02–0.39; I2=6%) for motor function of the paretic arm to 0.61(95%CI 0.41–0.82; I2=41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences withrespect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions andactivities showed equal or unfavorable effects when compared to other training interventions. Main limitations of thepresent review are not using individual patient data for meta-analyses and absence of correction for multiple testing.
Conclusions:
 

There is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases post stroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.
Citation:
 Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, et al. (2014) What Is the Evidence for Physical Therapy Poststroke? A SystematicReview and Meta-Analysis. PLoS ONE 9(2): e87987. doi:10.1371/journal.pone.0087987
Editor:
 Terence J. Quinn, University of Glasgow, United Kingdom
Received
 October 29, 2013;
 Accepted
 December 30, 2013;
 Published
 February 4, 2014
Copyright:
 
 2014 Veerbeek et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permitsunrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding:
 This research project was supported by the Royal Dutch Society for Physical Therapy (KNGF grant no. 8091.1; http://www.fysionet.nl/). The funders hadno role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests:
 The authors have declared that no competing interests exist.* E-mail: g.kwakkel@vumc.nl

Introduction

Prospective studies have estimated that about 795.000 people in the USA suffer a first or recurrent stroke each year [1]. The prevalence of chronic stroke in the USA is estimated at about 7million [1], with about 80% of patients with stroke being over the age of 65. The prevalence of stroke is likely to increase in the future due to the aging population. Even though acute stroke care (Quit talking about 'care', just tell us recovery and results.)has improved, for example by large-scale application of recombinant tissue plasminogen activator (rTPA) [1,2] and organized interdisciplinary inpatient stroke care [3], and although mortality rates have been decreasing [1], a large number of patients still remain disabled regardless of the time that has elapsed post stroke.Only 12% of the patients with stroke are independent in basic activities of daily living (ADL) at the end of the first week [4]. In the long term, 25–74% of patients have to rely on human assistance for basic ADLs like feeding, self-care, and mobility [5].Interdisciplinary complex rehabilitation interventions [6,7] are assumed to represent the mainstay of post stroke care [8]. One of the key disciplines in interdisciplinary stroke rehabilitation is physical therapy which is primarily aimed at restoring and maintaining ADLs, usually starting within the first days and often continuing into the chronic phase post stroke [8]. While the interdisciplinary character of stroke rehabilitation is paramount,the availability of specific, up-to-date, and professional evidence-based guidelines for the physical therapy profession is crucial for making adequate evidence-based clinical decisions [9–11]. The recommendations in the first Dutch evidence-based ‘Clinical Practice Guideline for physical therapy in patients with stroke were based on meta-analyses of 123 randomized controlled trials(RCTs) and date back to 2004 [12]. In view of the tremendous growth in the number of RCTs in this field, it is now necessary to re-establish the ‘‘state of the art’’ concerning the evidence for physical therapy interventions in stroke rehabilitation. This aim is in line with the 2006 Helsingborg Declaration on European Stroke Strategies(Which I consider a total failure for not even trying for 100% recovery), which states that stroke rehabilitation should be based on evidence as much as possible [13,14]. The first aim of the present systematic review was to update our previous meta-analyses of complex stroke rehabilitation interventions in the domain of physical therapy, based on RCTs with a low risk of bias (i.e. a moderate to good methodological quality) with no restrictions to the comparator. Primary outcomes, measured post intervention, were defined at the levels of body functions and/or activities and participation of the International Classification of Functioning, disability and health model (ICF) [15]. The second aim was to explore whether the timing of interventions post stroke moderated the main effects.

 

More at link

European Stroke Organisation (ESO) and Stroke Alliance for Europe (SAFE) initiated the implementation phase of the Stroke Action Plan for Europe 2018-2030

100% recovery is nowhere in this plan.  YOU need to get involved, you can't leave this up to stroke medical professionals, it is just as fucking useless as the inadequate Helsingborg declarations.

Where the fuck is the goal for 100% recovery for all survivors? Leaders would tackle such a goal. 

Helsingborg 1996

Helsingborg 2006

 

 European Stroke Organisation (ESO) and Stroke Alliance for Europe (SAFE) initiated the implementation phase of the Stroke Action Plan for Europe 2018-2030

10.09.2020 Basel – European Stroke Organisation (ESO) and Stroke Alliance for Europe (SAFE) initiated the implementation phase of the Stroke Action Plan for Europe 2018-2030, with a virtual meeting of over 80 experts from 52 countries, each involved within their national scientific societies or stroke support organisations.

The Stroke Action Plan sets targets for 2030 that include a major reduction in new strokes, stroke unit care as first level of care, and national plans for stroke services. At present, less than half of all patients with stroke in Europe receive appropriate care, with large inequalities between and within countries. By adopting evidence based principles of prevention and care, the burden of stroke in Europe can be substantially reduced with large cost savings for the society.

In his introduction, ESO President Prof. Martin Dichgans, Munich reinforced the initiative’s overall goal of creating a framework that will assist countries to improve stroke care across Europe. It is “only with the involvement, collaboration and joint effort of you, the representatives of national scientific societies and patient organisations, that this aim can be achieved”, he said.

The SAP-E Steering Committee presented detailed insights regarding the preparation work and achievements to date as well as an outlook for the upcoming years.

Arlene Wilkie, SAFE Director General, identified the major unmet needs from the perspective of patients and carers in the different regions of Europe. Prof. Hanne Christensen, Copenhagen outlined how the Stroke Action Plan shall be implemented on a national level: “By signing a SAP-E declaration, Ministries of Health, Stroke Support Organisations and Stroke Scientific Societies commit to support and act proactively within the plan in their countries to reach the targets of SAP-E”.

Components of the plan include prevention, care, surveillance, and monitoring of key performance indicators across Europe. As a pan-European initiative, SAP-E will convene authorities, health care providers and patients together to reduce the burden of stroke by a collaborative and systematic effort. The SAP-E is the largest stroke project ever undertaken in Europe.

The official Stroke Action Plan for Europe publication and further detailed information can be found on the Action Plan Website. https://actionplan.eso-stroke.org/

Contact:

ESO Head Office

esoinfo@eso-stroke.org

 

Status and Perspectives of Acute Stroke Care in Europe

I call complete bullshit on this reporting. Stroke is not treatable and you lazy fuckers have done nothing to get closer to 100% recovery.  I hope comeuppance hits all of you really hard.
Bo Norrving shouldn't be commenting at all, I saw nothing he accomplished when he was president of the WSO.
YOU need to get involved, you can't leave this up to stroke medical 'professionals', they came up with the inadequate Helsingborg declarations.

Helsingborg 1996

Helsingborg 2006

 

Status and Perspectives of Acute Stroke Care in Europe

Urs Fischer

,

Diana Aguiar de Sousa

,

Bo Norrving

, and

Valeria Caso

Originally published30 Aug 2018Stroke. 2018;49:2281–2282

Stroke is the second most common single cause of death in Europe and the leading cause of long-term disability.^1,2 Every year, up to 1.3 million persons in Europe suffer a first-ever stroke.³ Consequently, the socioeconomic impact of stroke is considerable with an annual cost in Europe of up to €45 billion.¹ Projections show that the overall stroke burden in Europe will further increase by 35% in 2050, mostly because of the aging population.⁴ However, there is overwhelming evidence that an acute ischemic stroke is no longer an unavoidable fate because strokes can be prevented and treated(10% full recovery is not being treated successfully), dramatically reducing the burden of stroke and its long-term consequences.
Endovascular treatment (EVT) has recently become the standard of care(NOT RECOVERY!) in stroke patients with large vessel occlusions, and it is now, together with stroke unit (SU) treatment and intravenous thrombolysis (IVT), a main pillar of acute stroke management.(But you never tell us its full success rate , so I call that a failure.) However, and despite much discussion on the necessary overhaul of stroke systems of care(NOT RECOVERY!), information on access and delivery of these acute stroke treatment strategies in Europe was lacking. In a recent publication in the European Stroke Journal, Aguiar de Sousa et al⁵ surveyed the status of acute stroke treatment in Europe.

Current Status of Acute Stroke Care(NOT RECOVERY!) in Europe

A survey drafted by stroke professionals from the European Stroke Organisation, the European Society of Minimally Invasive Neurological Therapy, the European Academy of Neurology, and the patient organisation Stroke Alliance for Europe was sent to national stroke societies and experts requesting best available national data on the number of SUs, as well as IVT and EVT rates, per year. Experts from 44 of 51 European countries provided data. Out of the 7 nonparticipating countries, 5 were from Eastern Europe. The authors compared both pooled and individual national data per 1 million inhabitants (United Nations data) and per 1000 annual incident ischemic strokes (Global Burden of Disease Report) with the best-performing countries.(Well fuck, you didn't request surveys from survivors asking how well they recovered because you didn't want to publicize your complete failure in getting them 100% recovered.)
The estimated mean number of SUs was 2.9 per 1 million inhabitants and 1.5 per 1000 annual incident strokes; highest country rates were 9.2 and 5.8, respectively. Forty-two countries provided the annual number of IVTs. The estimated mean annual number was 142 IVT per 1 million inhabitants, whereas 4 countries had rates per million above 350. Overall, 7.3% of all patients with an ischemic stroke in Europe received IVT. However, 15 countries had IVT rates <5%, whereas 6 countries reported that at least 15% of their patients received this treatment. The annual number of EVT was provided in 39 countries and was mostly for 2016. The estimated mean annual number of EVTs was 37.1 per 1 million inhabitants. Importantly, the annual number of treatments was estimated to be <10 per 1 million inhabitants in 13 countries, whereas rates for the 3 best-performing countries were 3× higher than the overall mean (up to 111.5). Overall, only 1.9% of incident ischemic stroke patients received EVT, whereas the top 3 countries reported rates above 5%.
These data showed that for most countries access to and delivery of SU care(NOT RECOVERY!) along with both IVT and EVT rates varied significantly, and in most countries, rates were far below best performers. The discrepancy means that 226 662 more patients could have been treated with IVT (339 929 instead of 113 267) and 67 347 with EVT (94 852 instead of 27 505), if best practice would have been followed in all countries. Although these are still rather conservative estimates, this means that two-thirds of patients that would potentially be eligible for IVT and three-quarters of candidates for EVT did not receive these treatments in Europe.
This survey provides a comprehensive snapshot of acute stroke care(NOT RECOVERY!) standards in European countries. These results are valuable for all stakeholders responsible for drawing up and implementing long-term strategies. The major limitation of this investigation was that it relied on surveyed data. Although it was requested that only best available information has to be utilized to compile the survey, in countries lacking organized nationwide registries, data came from variable sources, namely recent health ministerial statistics, service reports, national stroke registries, and estimates made by a consensus of coordinators and experts. In addition, no audit could be performed to assess the quality of the data. A larger prospective survey is planned for 2019.

Perspective of Acute Stroke Care in Europe

The findings of this survey have implications for the future organization of acute stroke care(NOT RECOVERY!) standards throughout Europe. In 2006, the second Helsingborg Declaration, cosponsored by the World Health Organization Regional Office for Europe, set new targets for stroke management and care(NOT RECOVERY!).⁶ One specific goal for 2015 was that all patients with acute stroke who were potentially eligible for acute specific treatment should be transferred to hospitals with adequate capacity and expertise to administer treatments—defined as an SU or stroke dedicated area. The current survey suggests that this goal still is far from being reached.
The European Stroke Organisation has therefore prepared a European Stroke Action Plan (ESAP) for the years 2018 to 2030, in cooperation with the European patient organisation Stroke Alliance for Europe.⁷ The ESAP adheres to the format of the Helsingborg Declarations, presenting a review of the state of the art, the state of current services, research and development priorities, and targets for a series of domains in stroke care(NOT RECOVERY!) (organization of stroke services, management of acute stroke, prevention, rehabilitation, evaluation of stroke outcome, and quality assessment). The ESAP includes 2 additional domains, on primary prevention and life after stroke, along with research and development priorities for translational stroke research. The ESAP was prepared in an open, transparent process that involved >100 scientists and patient organization representatives from almost all of the European countries. A live-streamed consensus workshop was held in Munich, March 22 to 23, 2018. The ESAP was launched at the European Stroke Organisation Congress in Gothenburg in May 2018, and the publication of the document is currently being finalized.
ESAP provides 32 specific targets for 7 domains. Four overarching targets were identified:

1. To reduce the absolute number of strokes in Europe by 10%.
2. To treat 90% or more of all patients with stroke in Europe in a dedicated SU as the first level of care(NOT RECOVERY!).
3. To have national plans for stroke encompassing the entire chain of care(NOT RECOVERY!) from primary prevention to life after stroke.
4. To fully implement national strategies for multisector public health interventions to promote and facilitate a healthy lifestyle, and reduce environmental (including air pollution), socioeconomic, and educational factors that increase the risk of stroke.
   Where the fuck is the goal for 100% recovery for all survivors? Leaders would tackle such a goal. 

An ESAP implementation plan will be prepared by European Stroke Organisation after having assessed an updated epidemiological report on stroke incidence, prevalence, and mortality and receiving detailed and reliable data from quality registries from national stroke and patient societies. Progress toward the targets and research and development priorities laid out in the ESAP will be reviewed in 2021 and 2024, with a midterm review scheduled for 2024. The extent to which the targets have been achieved will be reviewed in 2030.
Clearly, the implementation of the ESAP is a big challenge, which involves financial factors, as well as policy issues. Preventing and treating stroke should be seen as an investment for the society that has a favorable return, both social and economical, rather than just a cost to the healthcare sector. Governmental bodies need to substantially upscale efforts for stroke, along with other noncommunicable diseases, requiring a change of strategy in many of the European countries. National stroke and neurological societies will have a key role in the implementation of the targets. Role models of stroke management have been identified (ie, Austrian Stroke Network, Code Stroke System of Catalonia), as well as national quality registers currently set up in several European countries.
The ESAP is likely the most comprehensive and detailed plan for improvement of prevention and care(NOT RECOVERY!) of stroke in any large geographical region of the world, emphasizing the need to invest in stroke proportionally to the public health impact of the disease. Hopefully, this plan could also become an inspiration for other areas in the world. As Larry Elder said, “A goal without a plan is just a wish”.⁸

Disclosures

Dr Fischer is a Consultant for Medtronic, Stryker, and Commonwealth Serum Laboratories Behring. He is a principal investigator of the SWITCH (Swiss Trial of Decompressive Craniectomy Versus Best Medical Treatment of Spontaneous Supratentorial Intracerebral Hemorrhage (SWITCH): A Randomized Controlled Trial), ELAN (Early Versus Late Initiation of Direct Oral Anticoagulants in Post-Ischaemic Stroke Patients With Atrial Fibrillation: An International Multicenter, Randomized-Controlled, Two-Arm, Assessor-Blinded Trial), and SWIFT DIRECT trial (Solitaire With the Intention for Thrombectomy Plus Intravenous t-PA Versus DIRECT Solitaire Stent-Retriever Thrombectomy in Acute Anterior Circulation Stroke). Dr Norrving receives Honoraria for Data and Safety Monitoring Board work for Astra Zeneca and Bayer. Dr Caso receives Advisory boards and speaker fees for Bayer, Boehringer Ingelheim, BMS-Pfizer, Ever-Neuropharma. She also participated in a trial for Brainsgate and in the NAVIGATE-ESUS (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source), RESPECT-ESUS (Dabigatran Etexilate for Secondary Stroke Prevention in Patients With Embolic Stroke of Undetermined Source), and SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes). The other author reports no conflicts.

Footnotes

The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.

Correspondence to Urs Fischer, MD, MSc, Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland. Email urs.fischer@insel.ch

AARP Invests $60 Million to Fund Research for Cures to Dementia and Alzheimer's

This Dementia Discovery Fund is bringing together the best minds to work on dementia. Stroke leaders tried to do that and  they came up with the inadequate Helsingborg declarations.

Helsingborg 1996

Helsingborg 2006

The WSO had their World Stroke Organization Synergium in 2010 and you can see why in my opinion it is totally worthless.

 

AARP Invests $60 Million to Fund Research for Cures to Dementia and Alzheimer's

Dr. Ethel Percy Andrus

founded AARP in 1958, we have fought to make life better for people as they age. AARP has led the fight to end mandatory retirement; protect Social Security, Medicare and Medicaid; preserve and improve pension rules; protect older workers; ensure access to affordable quality health care; and make communities more livable for people of all ages. Now, as we commemorate our 60th anniversary, we are taking on what may be our toughest challenge yet — supporting the search for a treatment and, ultimately, a cure for dementia.

AARP’s Brain Health Fund is investing $60 million in the Dementia Discovery Fund (DDF), which invests in research and development of breakthrough treatments for dementia. This move reflects AARP’s ongoing commitment to helping people with dementia and family caregivers, and makes AARP the single largest investor in the DDF. 

More than 6 million people in the United States suffer from various types of dementia, including Alzheimer’s disease, and those numbers are growing at an alarming rate. Based on current projections, by 2050 that number will exceed 16 million, or about 1 in 5 Americans age 65 and older.

Dementia also takes a devastating emotional, financial and physical toll on the families of those who are diagnosed with these ailments. In 2016, nearly 16 million family members and friends provided more than 18 billion hours of unpaid caregiving assistance to those with Alzheimer’s and other types of dementia.

Tweet Jo Ann

Join me in the discussion about disrupting dementia on Twitter, @JoAnn_Jenkins.

Aware of the broad impact of these illnesses, researchers have worked hard to find effective treatments. But dementia is a complicated illness. Hundreds of clinical trials have failed, and some advances once thought to be promising have turned into dead ends. Several drug companies have stopped conducting research. A new approach is needed. 

By bringing together the world’s best minds to accelerate global research efforts, the DDF will help to kick-start a different approach to dementia research by applying the venture capital model, common in Silicon Valley, to fund research toward new therapies. Founded in 2015, the fund already has invested in 16 organizations exploring new pathways for treating dementia.

AARP has long been committed to raising awareness of dementia-related illnesses and educating people age 50 and older — and their caregivers — on how to maintain brain health while supporting those who suffer from dementia. This investment in the DDF also provides hope for the future by recognizing that the urgent need to find better treatments will require cooperation among researchers, public health agencies and investors. 

For six decades, AARP has focused on finding solutions that improve the lives of older Americans, and we will continue to do so as the challenges that each generation faces change. Only 12 years from now, the first millennials will be turning 49, Gen Xers will begin turning 65 and the first boomers will be turning 84 — an age at which dementia is most prevalent. By making this investment, our hope is that, by then, we can add finding a treatment and ultimately a cure for dementia to the list of battles we have won.

More on Brain Health

• The next wave of brain research
• Is it dementia? Everyday signs that merit a doctor visit
• What we know (and don’t know) about Alzheimer's disease

Europe Launches Ambitious Plan to Elevate Stroke Care

FUCKING USELESS! 'CARE' NOT 'RESULTS'.  Does no one want to tackle stroke BHAGs(Big Hairy Audacious Goals) of 100% recovery for all survivors?  Or are you all too chickenshit to even acknowledge that everything in stroke is a failure.
Bo Norrving shouldn't be commenting at all, I saw nothing he accomplished when he was president of the WSO.
YOU need to get involved, you can't leave this up to stroke medical professionals, they came up with the inadequate Helsingborg declarations.

Helsingborg 1996

Helsingborg 2006

 

Europe Launches Ambitious Plan to Elevate Stroke Care 

GOTHENBURG, Sweden — Improving access to specialized stroke expertise, elevating the quality of care for all Europeans by 2030, and setting research priorities are the focus of an ambitious collaborative project led by the European Stroke Organisation.

Four overarching targets of the new Stroke Action Plan for Europe (2018 - 2030) include reducing the number of strokes in Europe by 10%, treating 90% or more of all patients in a dedicated stroke unit, creating national plans that address stroke from prevention to life after stroke, and promoting strategies that reduce stroke risk on a population level.  

These targets were announced here at the 4th European Stroke Organisation Conference (ESOC) 2018.

Action is needed because less than half of the population now has access to specialized stroke care, organizers say. Current capacity contributes to this challenge.

"The biggest problem is there are not enough stroke centers in Europe," Bo Norrving, MD, professor of neurology at Lund University in Sweden and chair of the stroke action plan, told Medscape Medical News during a media briefing here at ESOC. "The second problem is the best available are not enough — patients come to our hospitals and are placed on the wrong ward."

The insufficient number of stroke unit beds signals a major disconnect between specialized stroke resources and the magnitude of stroke's burden across the continent. "There is a profound mismatch in this area," said Norrving.

Stroke remains the second leading cause of death and number one cause of long-term disability among Europeans, said Jon Barrick, co-chair of the European Stroke Action Plan and president of the Stroke Alliance for Europe (SAFE), a patient advocacy group collaborating with ESO.

"In terms of the world's great killers, stroke research is underfunded," Barrick added. "If stroke continues to be under-resourced in the way it is, it is quite credible stroke will go from the number two killer to number one."

"The Burden of Stroke in Europe" report, published by SAFE in 2017, provided a snapshot of stroke services and predictions for the future. There are, for example, €45 billion direct and indirect healthcare costs each year associated with stroke. "If everything continues as is, there will be a 35% increase in stroke by 2030. Something needs to be done," Barrick said.

Putting a more positive spin on the situation, Norrving said short-term investments to boost stroke resources and access to expertise represents "a great return on investment" over the long term compared to other conditions.

"One of the best stocks you can buy today is to invest in stroke care."

The new Stroke Action Plan announced at ESOC 2018 follows two previous attempts to improve stroke care across Europe. Advances in science, technology, and therapy for stroke care could improve the chances of success compared to the two earlier "Helsingborg Declarations" in 1995 and 2006.

 

The Action Plan for Stroke in Europe 2018 to 2030

YOU need to get involved, you can't leave this up to stroke medical professionals, they came up with the inadequate Helsingborg declarations.

Helsingborg 1996

Helsingborg 2006

http://www.safestroke.eu/2017/06/08/action-plan-stroke-europe-2018-2030/ 

The Action Plan for Stroke in Europe 2018 to 2030 will be of major importance for the prevention of stroke in Europe and the implementation of adequate stroke services.
Two previous consensus conferences on stroke management in Europe have been held in 1994 and 2006. Both conferences were organised by the European Stroke Council (1994) and the International Stroke Society (2006) in cooperation with WHO EURO. The consensus documents (The Helsingborg Declaration 1996 and 2006) were utilised as the basis for setting up and planning stroke services. The declarations reviewed current evidence, set up fixed targets, and identified prioritized areas of research.
A third consensus conference is scheduled to take place in Munich in 2018, building on the experience and the format of the previous conferences. The conference will be organized by the European Stroke Organisation, in cooperation with the patient organisation Stroke Alliance for Europe (SAFE). The World Stroke Organization will be asked to endorse the conference.
There will be seven domains of the Action Plan, five from the Helsingborg Declaration, plus Primary Prevention and Life after Stroke.

1. Primary Prevention
2. Organization of Stroke Services
3. Management for Acute Stroke
4. Secondary prevention and organized follow-up
5. Rehabilitation
6. Evaluation of Stroke Outcome and Quality Assessment
7. Life after stroke

Each domain of the Action Plan will have 1 chairperson, and 7 other members. For each domain, there will also be two additional persons who will be responsible for the identification of the Prioritized Research Areas. Each domain will include a review of the 2006 target results, an analysis of what worked and what did not, an update of current state of the art, proposals for 2030 targets, and the identification of Prioritized Research Areas.
Besides the Prioritized Research Areas of the first six domains (without life after stroke), there will also be a separate group who will be in charge of identifying Prioritized Research Areas for translational stroke research.

Please read next:  Higher dementia risk associated with birth in high stroke mortality states

⦁ Translational Research Priorities Group
The Action Plan will be led by a 12-member steering committee, 6 of whom will constitute the core working group. Members of the steering committee will include representative(s) from WHO EURO.
The draft documents will be prepared prior to the ESOC 2018 in Gothenburg

Patients and carers expertise important for the credibility of the European Stroke Action Plan

As far as I could tell Bo Norrving did nothing useful for stroke survivors when he was president of the World Stroke Organization.  The Helsingborg Declaration did nothing about setting goals on stroke results, just continuum of care. All hat and no cattle!

Patients and carers expertise important for the credibility of the European Stroke Action Plan

Bo Norrving is a professor in neurology at Lund University, Sweden. He has authored more than 400 publications on clinical stroke research, including several seminal papers e.g. the Swedish Aspirin Low Dose Study, and the world’s largest study of stroke in the young. He is a founder of the Swedish Stroke Register (Riksstroke), the world’s 1st national stroke registry. He is a member of the advisory group for ICD 11 at WHO. He was the President of the World Stroke Organization (WSO) 2008-2012, and chairs the WSO Global Policy Committee. He is the editor-in-chief of the European Stroke Journal.
Having in mind that he was one of the editors of the important 2006 Helsingborg Declaration on European stroke strategies, the European Stroke Organisation and SAFE are proud and honored to have Prof. Norrving now coordinating a joint ESO and SAFE project called “Stroke Action Plan for Europe 2018-2030”.

Prof. Bo Norrving; Photo: Henrik Rosenqvist

SAFE: Stroke Support Organisations are only just beginning to be formed and to grow in quite a lot of countries; do you think that medics are fully aware of how important they are in influencing decision makers on allocations of funding and resources to things like stroke care, stroke research and public awareness? If not as aware what is ESO doing to encourage medics to aid the growth of SSO?
BN: I think the full importance is still not well recognized. There are many examples where the initiatives of SSOs have been critically important. It’s an important task for ESO to support formation of new SSOs and to support and collaborate with existing ones. ESO and SAFE have recently joined forces in several actions and projects (e.g. at the EU, the European Stroke Action Plan), and I am sure there will be many more in the future.
SAFE: SAFE is going to launch the Stroke Action Plan for Europe in the EU Parliament as part of European Stroke Action Month in May 2018. What plans have ESO made for their members to aid public awareness raising with SSO’s in this month?
BN: I expect that ESO will join SAFE at the EU Parliament as a demonstration of the collaboration between ESO and SAFE on the Action Plan. I expect that stroke professionals will align with SSOs all across Europe and work together, this is a joint task. I was impressed by the enormous success in social media of the recent World Stroke Day, and the stroke action month next May is another good opportunity to raise awareness.
SAFE: Stroke professionals and stroke survivors and their carers will be working together on Stroke Action Plan for Europe, what would be the quality / insight you expect to get from including non-medics in writing recommendations for the Stroke Action Plan for Europe?
BN: Including the expertise from patients and carers is perennially important, and helps to make the European Stroke Action Plan credible. In many countries SSOs are now included in guidelines work, and speaking from my own country I am happy to report that this is now routine and mandated at the National Board of Health and Welfare and the quality registers level.

Please read next:  Low-cost therapy produces long-lasting improvements for stroke survivors

SAFE: What would be the main difference between the Helsingborg Declaration and the Stroke Action Plan for Europe?
BN: The Stroke Action Plan for Europe now includes primary prevention and Life after Stroke as new domains, which makes the new document more complete. Furthermore, the working process is now more transparent will possibility for anyone to provide comments and input.
SAFE: Are the goals set by Helsingborg Declaration met and if not, what were the main obstacles, and issues that were not met?
BN: The targets are unfortunately not met, and the most flagrant in my opinion is a widespread lack of stroke unit beds across almost all parts of Europe. Other issues are unavailability of acute therapies in many regions and areas, and weak organisations for rehabilitation and follow up. Stronger actions from ministries of health and hospital administrators would have been needed; I hope that the new action plan will achieve this with more power than during the past 10 years.
SAFE: The work on Stroke Action Plan for Europe is divided in seven parts, or domains as they were called, covering all aspects of stroke, from prevention to  life after stroke. Once made, how do you plan to bring these recommendations to life and make impact on decision makers across Europe?
BN: This discussion has only started and plans are not developed in detail, but ESO will likely establish an implementation committee to coordinate the actions. One of the first steps will be to advocate for country-specific action plans based on gap analyses, as stroke prevention and services vary so much between countries. Even with common targets for the whole of Europe, we need to remember that every country is autonomous in decisions of health care. Interim targets needs to be set and should be reviewed regularly. The use of learning from “good examples” between countries and regions will be important stimuli to achieve the targets.
SAFE: We learned from the Burden of Stroke Report, presented in May this year, that there are not enough studies about life after stroke, which is the main topic of the seventh domain in the Stroke Action Plan for Europe. How do you plan to deal with this topic which is so important to stroke survivors and their families?
BN: Each domain of the Action Plan has a section on research priorities, and I expect that this will be highlighted in the Life after Stroke section. I think that this research area is growing already now, and the Action Plan will help to give its support.
SAFE: When is the final document of the Stroke Action Plan for Europe due to be published?
BN: There will be the workshop in Munich March 21 to 23rd, and then the launch of the final document at the ESOC in Göteborg in May where a session is scheduled for Thursday May 17 14:30 to 16 in the main program. The document will be published in a scientific journal as soon as possible thereafter.

Action Plan for Stroke in Europe 2018-2030

Trying to update the Helsingborg Declaration. I can guarantee it will be worthless, no survivors will be there.
http://mailchi.mp/fa0fe9d26d1b/5th-eso-esmintesnr-stroke-winter-school?t=1&cn=ZmxleGlibGVfcmVjc18y&refsrc=email&iid=1e6e02be22c746d7befbb0cd252976b1&uid=625967110&nid=244+281088008

The 7 Domain groups are now confirmed and 77 persons have been invited to update the 2006 Helsingborg Declaration. Each Domain Group works on its allocated topic and we expect to have a first draft ready in December 2017. The Draft manuscript will be available for public comments in February 2018, just before the meeting takes place in Munich, 21-23 March 2018.

For the onsite conference participation, you have the possibility to submit your application. Seats are very limited and you will be informed in December 2017 if your application has been accepted. Please note that there is no registration fee but the travel costs and/or overnight stays are at your own expenses.

*** Deadline for application is 3rd November 2017 – Apply here***

Treatment of stroke in Europe: the Helsingborg Declaration - from 1995

Notice they don't talk about RESULTS, just 'CARE'. No wonder stroke never gets anywhere. No one ever takes responsibility for solving all the problems in stroke. All they are doing is saying they care., but never do anything useful for survivors. They should all be keel hauled.
https://www.ncbi.nlm.nih.gov/pubmed/9190521

[Article in Dutch]

Limburg M¹.

Author information

Abstract

Late in 1995, the Helsingborg Declaration was adopted, a European consensus text on the basic elements for policy in, and objectives of treatment of strokes. This declaration was prompted by the fact that the differences in incidence in different European countries, and the changes of the incidence in the course of the years suggest a great importance of environmental factors that can be influenced. The organizers of this consensus meeting might have enhanced the value of the document by more exactly indicating the (scientific) strength of the argumentation for each recommendation. Nevertheless, many of the recommendations are based on solid evidence. A plea is made to structure stroke care, measure the quality of care, facilitate early diagnosis and therapy after stroke, improve the possibilities for rehabilitation, and apply appropriate secondary prevention.

PMID:

9190521

Helsingborg Declaration on European Stroke Strategies, 2006

I saw absolutely nothing in Helsingborg that had any assigned goals so I'm sure zilch came out of this except for conscience laundering which does absolutely fucking nothing for survivors. 

Helsingborg Declaration on European Stroke Strategies, 2006

Edited by: T.Kjellström, B.

Norrving, A. Shatchkute

B. Norrving was the former president of the WSO, I saw nothing useful come out of there except how not to run a stroke symposium.

ABSTRACT

The Second Consensus Conference on Stroke Management took place from 22 to 24 March 2006 in Helsingborg,

Sweden. The meeting was arranged by the International Stroke Society,

endorsed by the European Stroke Council and

International Stroke Society, and co-sponsored by the WHO R

egional Office for Europe. It was arranged in collaboration

with the European Region of the World Confederation

for Physical Therapy and the European Association of

Neuroscience Nurses. The patients’ organization Stroke Alliance for Europe also participated.

The meeting adopted the Helsingborg Declaration 2006 on European

Stroke Strategies, a statement of the overall aims

and goals of five aspects of stroke management (organiza

tion of stroke services, management of acute stroke,

prevention, rehabilitation, evaluation of stroke out

come and quality assessment) to be achieved by 2015. 
If something was done by 2015 it sure is not visible. Why would you want to notify stroke survivors about this anyway?