Centralising stroke services can save lives
Changing access to more specialised stroke centre care in one city (London) was estimated to save an additional 96 lives per year (1%) compared to the reductions occurring in the rest of England. These improvements were sustained over time. Other cities did well on quality of care indicators, including time to admission in a stroke unit and length of stay. Patients and carers reported good experiences despite slightly increased travel times to the central stroke units.
A stroke can have devasta...
Transcutaneous electrical stimulation (TENS) may help lower limb spasticity after stroke
Transcutaneous electrical stimulation (TENS) delivered alongside standard physical therapies could reduce spasticity in the lower limbs following a stroke.
Spasticity is a muscle control disorder characterised by tight muscles. It is common after stroke and accounts for significant disability. TENS is often used to treat pain and can affect nervous stimulation of the muscles.
The main evidence in this systematic review came from five trials which suggested that TENS combined with other physica...
A commonly-used antidepressant doesn’t improve recovery after stroke
The antidepressant fluoxetine works no better than placebo to reduce disability after a stroke, lowering hopes that had been raised by other smaller studies.
After a six month trial including more than 3,000 adult stroke patients recruited at 103 UK hospitals, researchers concluded that fluoxetine should not be used to promote recovery from stroke-related disability, or routinely prescribed to prevent depression after stroke.
Several smaller studies and animal trials had found promising result...
Robot-assisted arm training after stroke helps people regain some strength and independence
People who have electromechanical or robot-assisted arm rehabilitation after stroke have better arm function and strength as well as finding it easier to complete activities of daily living. Although moderate, the improvements suggest it may be worth considering these interventions as an adjunct to usual therapy.
Many people have impaired arm function after a stroke and rehabilitation is often required. Robot-assisted arm training uses devices to support therapeutic movements. Feedback, given b...
Two antiplatelet drugs may prevent further strokes but increase major bleeds
People experiencing a minor stroke or a transient ischaemic attack have a lower risk of further stroke within 90 days if given clopidogrel and aspirin, rather than aspirin alone. However, taking both drugs doubles the risk of bleeding over the same period.
Current UK guidelines recommend using clopidogrel alone.
In this major international trial of nearly 5,000 people, those who took the dual treatment had fewer heart attacks or strokes than those who took aspirin only, particularly in the fir...
Adding a third antiplatelet drug after a stroke doesn’t reduce the risk of another stroke
A combination of aspirin, clopidogrel and dipyridamole does not reduce the incidence or severity of recurrent stroke in people who have had a stroke or transient ischaemic attack (TIA).
This NIHR-funded trial compared the triple treatment to current guideline-based antiplatelet therapy for preventing further stroke or TIA (brief loss of blood supply to the brain). UK guidance recommends aspirin initially followed by clopidogrel alone as for most people this gives the best balance of effectivene...
Direct acting oral anticoagulants likely to be better than warfarin for people taking them for atrial fibrillation
In people with atrial fibrillation needing anticoagulant treatment, deaths were fewer in those who had direct acting oral anticoagulants compared with warfarin. The picture is less clear for the risk of stroke and complications such as bleeding in the brain or gut. Apixaban had the best efficacy and safety profile and was cost-effective compared with warfarin.
This study pooled the data in all trials reporting efficacy, safety and cost of anticoagulant prevention of stroke events in people with...
Giving oxygen routinely after a stroke does not improve outcomes
There was no benefit to routinely giving oxygen to people who have had a stroke. Oxygen given continuously, or just overnight, did not reduce disability or death and it did not improve people’s ability to do everyday tasks or live independently. There were no oxygen-related adverse events reported.
Strokes occur when the blood supply to the brain is disrupted by either a blocked or burst blood vessel. They can lead to death or disability as parts of the brain are deprived of blood. Theref...
Second-hand smoke levels in Scottish prisons equivalent to living with a smoker
Staff in Scottish prisons inhale roughly the same amount of second-hand smoke at work as they would in the average smoking household (32μg of fine particulate matter per m3). Some activities, like inspecting a smoky prison cell, exposed staff to far higher levels (up to 753.6μg per m3).
Despite smoking bans in public spaces across the UK, around three-quarters of prisoners smoke. This poses health threats from second-hand smoke to staff and prisoners alike.
This NIHR study detailed the s...
Head position after acute stroke does not affect disability outcomes
Lying flat for 24 hours after a stroke is no better than sitting up at an angle of at least 30 degrees. These differences in early head position did not affect people’s levels of disability or survival to 90 days, which was more than 92% in both groups. It had been thought that the head down position might increase the chance of pneumonia, but in this trial, the rates were also similar for people cared for in either position.
The results of this large international randomised controlled t...