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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 cost-effective.
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 changes worldwide, 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 economy.
Attribution: Trials were designed and led by Professor M Dennis, UoE.
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.