Stroke is the third most common cause of death and single most important
cause of adult disability in the UK, affecting over 150,000 individuals
per annum and costing the economy approximately £8 billion annually in
health, social and indirect care costs.
High blood pressure (BP) is the most common modifiable risk factor to
prevent stroke, but the use of BP-lowering therapy in the acute phase of
stroke is controversial. Clinical trials co-ordinated at the University of
Leicester have confirmed the safety of continuation of pre-existing
BP-lowering therapy in acute stroke and the de novo treatment of high
blood pressure in acute intracerebral haemorrhage. This has resulted in
changes to the most recent US (2013) and UK (2012) guidelines, which will
significantly impact on clinical management of this common clinical
problem in acute stroke.
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.
Impact: Health and welfare; saving lives by determining that
aspirin is an effective treatment for
acute stroke and that heparin anticoagulation is ineffective.
Significance: In the UK, treating all acute stroke patients with
aspirin and avoiding heparin means
1800 people avoid death or disability each year; aspirin is also highly
Beneficiaries: Stroke patients, the NHS, the economy.
Attribution: Sandercock, UoE, designed, led and reported the
International Stroke Trial, and was
on the steering committee of the Chinese Acute Stroke Trial.
Reach: Up to 15M stroke patients annually affected by guideline
encompassing Europe, North America and Australasia; educational events by
the World Stroke
Academy promote aspirin use.
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.
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.
Impact: Health and welfare: reducing morbidity; providing evidence
to disinvest in an ineffective
and damaging treatment; policy change.
Significance: Since 2009, applied clinical trial findings have
resulted in approximately 6000 fewer
complications (e.g., skin breaks) in the UK. Stocking use has decreased by
95%, which has saved
the NHS in excess of £20M per annum.
Beneficiaries: Stroke patients worldwide, the NHS and healthcare
delivery organisations, the
Attribution: Trials were designed and led by Professor M Dennis,
Reach: Changed national guidelines in at least seven countries
worldwide (Europe, N America,
South Africa, Singapore).
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.
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.
Research by the University of Nottingham's Division of Rehabilitation and
Ageing has informed the effective implementation of evidence-based Early
Supported Discharge (ESD) and community services for stroke survivors. The
findings of an international consensus on the implementation of ESD have
played a significant role in shaping local, regional, national and
international service specifications. Qualitative and implementation
studies have helped to shape better working practices between acute and
community stroke services, including joint decision-making on who should
be eligible for ESD and ensuring that services derive the full benefits of
robust and relevant data capture.
Treating stroke consumes 5% of the NHS budget. Government objectives for
improving stroke rehabilitation have driven our important advances in
aiding recovery of movement and independence. We have developed and
evaluated innovative technologies and directly ensured translation into
clinical practice and home use. Over 2,500 therapists have received
training in functional electrical stimulation (FES) in the UK and abroad.
Our research into FES and upper-limb robot therapy has attracted great
media attention, as well as international clinical and commercial success.
FES is now incorporated into National Institute of Health and Care
Excellence (NICE) and Royal College of Physicians (RCP) Stroke Guidelines.
We have demonstrated successful adoption of technologies in practice (the
main UK commercial provider reports 16,000 sales of FES devices), and we
have published evidence for their continued use.