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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

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

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

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

Blood pressure management following acute stroke: informing changes to UK and US stroke guidelines

Summary of the impact

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.

Submitting Institution

University of Leicester

Unit of Assessment

Clinical Medicine

Summary Impact Type

Political

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurosciences

A: Reducing the global burden of stroke by using aspirin and avoiding heparin use in the treatment of acute stroke

Summary of the impact

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.

Submitting Institution

University of Edinburgh

Unit of Assessment

Psychology, Psychiatry and Neuroscience

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurosciences

C: Immediate CT scanning in acute stroke improves outcomes for patients and is very cost effective, whereas arteriography and MR scanning are not cost-effective in secondary prevention

Summary of the impact

Impact: Health and welfare; Wardlaw's work on diagnostic imaging in stroke prevention and treatment has effected changes to clinical guidelines worldwide, prevented thousands of strokes and decreased disability.

Significance: In the UK, changes in stroke treatment consequent upon effective imaging result in 6000 more quality-adjusted life-years and save ~£300M per year. Improved stroke prevention averts 1760 strokes and saves the NHS £30M per year.

Beneficiaries: Stroke patients, the NHS and healthcare providers in other countries

Attribution: The research took place entirely at UoE.

Reach: UK, Europe, N. America, Australasia.

Submitting Institution

University of Edinburgh

Unit of Assessment

Psychology, Psychiatry and Neuroscience

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Neurosciences

B: Graduated compression stockings do not reduce the risk of post-stroke deep vein thrombosis

Summary of the impact

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).

Submitting Institution

University of Edinburgh

Unit of Assessment

Psychology, Psychiatry and Neuroscience

Summary Impact Type

Health

Research Subject Area(s)

Medical and Health Sciences: Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurosciences

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

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

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