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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.