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Transforming stroke rehabilitation research and care

Summary of the impact

Forster, House and Young have played a leading role in establishing the importance of long-term psychological and social distress after stroke, shifting the clinical emphasis (and evidence base) in stroke care from a limited focus on physical recovery to acceptance of the importance of psychological and social factors. Evidence we have generated has informed the stroke care pathway in national and international clinical guidelines that influence stroke service delivery, by providing guidance to clinical teams on psychological treatments after stroke and information provision. In tandem we have developed the methodology of stroke rehabilitation research, involving clinical staff in delivery of multi-site studies and thereby enhancing evidenced-based stroke care.

Submitting Institution

University of Leeds

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Neurosciences, Public Health and Health Services

Influence of stroke rehabilitation practice and assessment methods on national and international clinical guidelines

Summary of the impact

Research at Nottingham, reviewing and evaluating best practice for care of stroke patients since 1993, has influenced clinical practice by contributing to key national clinical guidelines. Additionally, research at Nottingham has developed and validated existing stroke assessments with new publications encouraging the uptake of these assessments globally in Europe, North America, China and Japan. Finally, Nottingham researchers have achieved impact within the stroke community by working directly with patients to develop care pathways and building networks of clinicians, occupational psychologists, clinical psychologists and patients to ensure research translates effectively into real-world practice.

Submitting Institution

University of Nottingham

Unit of Assessment

Psychology, Psychiatry and Neuroscience

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Neurosciences, Public Health and Health Services

Specialist stroke services become the national standard of care

Summary of the impact

Worldwide, around 5 million stroke-related deaths occur annually, while another 5 million people are left with chronic disabilities following strokes. University of Glasgow research demonstrated that admission to a specialist stroke unit significantly improves patients' chances of survival and recovery. This discovery transformed the culture of stroke service delivery in the UK. These studies drove the development of new advice in national and international clinical practice guidelines and promoted the implementation of NHS healthcare targets and audit activities to standardise and evaluate the quality of stroke care. In the UK, the early death rate after stroke has fallen from over 45% to under 30% in the past 20 years; at least one-fifth of that decline is attributed to the introduction of stroke units.

Submitting Institution

University of Glasgow

Unit of Assessment

Clinical Medicine

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Neurosciences, Public Health and Health Services

South London Stroke Register: Informing Innovation in Stroke Care

Summary of the impact

The King's South London Stroke Register is the world's longest running, population-based stroke research register, assessing the incidence of stroke; the acute and long-term needs of stroke patients; and quality of stroke care. The South London Stroke Register provided data and analyses that informed the Parliamentary Public Accounts Committee report on stroke, the National Strategy for Stroke, and contributed to two National Audit Office reports on acute and longer-term stroke care. The latter contributed to a major service reconfiguration in London, which has led to lower mortality and more efficient use of health care resources for stroke. The King's South London Stroke Register provides a platform for designing and evaluating new models of stroke care, including the largest trial of Early Supported Discharge, a cost-effective intervention which is now provided in 66% of hospitals in England, as well as being rolled out internationally.

Submitting Institution

King's College London

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Neurosciences, Public Health and Health Services

Improvements in services enabling people of working age to reintegrate into the community after a stroke

Summary of the impact

Research evaluating a pilot service for people who had had a stroke showed that there was a lack of support to help them return to work, insufficient attention to individual needs and that their ability to reintegrate into the community was poor. Post-stroke conditions cost the UK economy £7 billion annually. The research findings have made a distinct and material contribution to refocusing services in Wales and England towards helping patients fit back into society after a stroke. Three out of ten services established in 2005/2006 in Wales and the original service continue, and have informed the development of further services in England. These services support patients to return to work and make other lasting improvements to their lives.

Submitting Institution

University of Northampton

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services

13: Stroke Units: Research driven excellence in quality stroke care

Summary of the impact

Stroke affects 15 million people globally and is a leading cause of death and adult physical disability. King's College London (KCL) research has provided the evidence that underpins many of the present day policies, guidelines and clinical practice for stroke care, not only in the UK but also in other countries. KCL research has demonstrated that stroke units are effective and reduce mortality and dependence by 22%. The implementation of these findings in England has increased the number of patients managed on a stroke unit from 18% to 62% between 2000-2012, preventing 550 deaths, enabling 1,700 more patients to make a full recovery and saving £82 million per year.

Submitting Institution

King's College London

Unit of Assessment

Psychology, Psychiatry and Neuroscience

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Neurosciences, Public Health and Health Services

1. Life After Stroke-Influence of Physical Fitness and Exercise

Summary of the impact

Every year 15 million people worldwide experience a stroke. Of these, 5 million die and 5 million are permanently disabled. Life after stroke is never the same for many survivors. The research by Mead and Saunders from 2001 to 2012 has demonstrated that exercise training improves the physical fitness and physical function of stroke survivors and thus improves their quality of life.

The research has influenced health policy by underpinning the production of National Clinical Guidelines for stroke in the UK (NHS England & Scotland) and internationally (Australia, NZ, Canada). It has also been used to design and develop exercise after stroke services which have been implemented in the UK since 2007.

Submitting Institution

University of Edinburgh

Unit of Assessment

Sport and Exercise Sciences, Leisure and Tourism

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Neurosciences

Re-organisation of ambulance services and increased public awareness of stroke symptoms through the Act FAST campaign have improved outcomes for stroke.

Summary of the impact

Stroke is a major health burden to patients, carers and the NHS, with UK costs estimated at £15.5bn annually. Clot-busting agents (thrombolytics) can substantially improve the consequences of ischaemic stroke, but only if administered rapidly. Newcastle research that recognised the importance of rapid referral to a stroke unit allowed reconfiguration of ambulance services for direct transport of victims to a specialised centre. Newcastle work also validated a test developed for paramedics to recognise the signs of stroke, which was developed as the nationwide Face-Arms-Speech-Time (Act FAST) campaign. Use of thrombolytics has increased eightfold between 2005 and 2012, and there has been a considerable increase in public awareness of FAST.

Submitting Institution

Newcastle University

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Clinical Sciences, Neurosciences, Public Health and Health Services

Reducing death and disability from stroke by raising awareness and improving emergency and hyperacute care

Summary of the impact

After the onset of stroke symptoms, much disability and death can be prevented by ensuring immediate access to effective specialist assessment and treatment. Our work on improving pathways of care in acute stroke has included research on raising public awareness of stroke, so that people seek emergency medical advice promptly, and research and development on emergency medical services' skills and practice. The findings of this research have led to impacts on clinical care and health services practice via inclusion in national and international clinical guidelines and training, improvements in the recognition of stroke, and reduced pre-hospital delays and time to emergency department diagnosis. Such improvements are known to reduce death and disability from stroke.

Submitting Institution

University of Central Lancashire

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services

Change in practice of stroke practitioners due to the Bridges stroke self-management programme

Summary of the impact

Bridges is a novel programme for self-management of stroke. Training in this programme has been delivered to health and social care practitioners across England, and has recently begun to be taken up in New Zealand. This has resulted in significant changes to the practice of post-stroke practitioners who have incorporated the Bridges programme into their practice, towards using more person centred and self-management approaches. Bridges is the first social enterprise spin out from Kingston University, and was successfully launched in 2013 following development grants from Unltd.

Submitting Institution

Kingston University

Unit of Assessment

Allied Health Professions, Dentistry, Nursing and Pharmacy

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services

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