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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

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

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

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

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

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

D: The FOOD trials: feeding policies in hospitalised stroke patients influence patient outcomes

Summary of the impact

Impact: Health and wellbeing; improvement in mortality and morbidity; changes in policy and guidelines.

Significance: Clinical trial findings have led to 1160 fewer deaths and 780 fewer severely disabled patients each year in the UK; rationalising feeding policies saves over £12M annually.

Beneficiaries: Stroke patients, the NHS and healthcare delivery organisations, the economy.

Attribution: Trials were designed and led by Professor M Dennis, UoE.

Reach: Worldwide: revised national guidelines in UK, Europe, North America, South Africa, Singapore, 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: Clinical Sciences, Neurosciences, Public Health and Health Services

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

Modelling phases of care

Summary of the impact

Acute stroke services in the Belfast Health and Social Care Trust have been reorganised using research on modelling stroke patient pathways through hospital, social and community services carried out in CSRI at Ulster. By suitably administering thrombolysis (clot-busting drugs), a stroke patient's time in hospital, community rehabilitation and nursing homes can be reduced, so that although the treatment costs money up front, it saves in the long-term and also improves quality-of- life. The work has contributed to changing stroke patient policy in the Belfast Trust as well as enhancing patient quality-of-life. It is applicable throughout the UK and beyond.

Submitting Institution

University of Ulster

Unit of Assessment

Computer Science and Informatics

Summary Impact Type

Health

Research Subject Area(s)

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

Assessment and management of emotional response to stroke and psychological recovery

Summary of the impact

We have conducted studies to improve the recognition and treatment of post-stroke psychological problems. Our Motivational Interviewing (MI) study was the first, and one of only a few studies to show a positive impact of a talk-based psychological intervention following a stroke. This study has been recognized nationally and internationally and there is evidence that stroke-specific staff are accessing training in MI (e.g. UK Stroke Forum Education and Training, and the National Stroke Foundation in Australia). We are also collaborating in further research to evaluate the use of MI in the adjustment to other illnesses such as HIV, indicating that our work is beginning to have an impact in other areas of healthcare. We have developed national competences to underpin the development of training on the recognition, screening and management of psychological problems and enhancing communication skills. This research has contributed to the National Clinical Guideline for Stroke, National Competences, and improvements in the recognition of psychological distress and timely initiation of psychological support.

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

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