Stroke

Stroke has a huge impact, leaving over a third of affected people with lasting disability affecting self-care. Although acute stroke interventions can reduce mortality and morbidity, rehabilitation remains a cornerstone treatment and is the focus of the research we conduct in the Stroke Portfolio.

The 1st Leeds Colloquium on Stroke Rehabilitation Research took place on April 17th 2013 and showcased some of the methodological issues arising from research conducted in the portfolio and how this represents a major step forward in addressing clinical research questions of importance to stroke survivors. The outcomes of the meeting are to be published as a consensus paper on stroke rehabilitation research.

The portfolio collaborates locally with the Academic Unit of Elderly Care and Rehabilitation, the Leeds Institute of Health Sciences, the Leeds Institute of Molecular Medicine and the Leeds Teaching Hospitals NHS Trust, and nationally with UK Stroke Research Network, the Universities of Newcastle, Nottingham, and East Anglia, King’s College London, the London School of Economics & Political Science and the Grampian Health Board.

Stroke Complex Intervention Trials

 Acronym  Title Other Research Areas  Status
DARS  Does Co-careldopa treatment in combination with routine NHS occupational and physical therapy, delivered early after stroke within a stroke rehabilitation service, improve functional recovery including walking ability and arm function? Drug Trial Closed
LoTSCare  Cluster randomised trial evaluation of a patient and carer-centred system of longer-term stroke care
 Closed
TRACS  A cluster randomised controlled trial of a structured training programme for caregivers of in-patients after stroke
 Closed

Stroke Programme Grants

Acronym  Title  Status
LoTS2Care  Development and evaluation of strategies to provide longer-term health and social care for stroke survivors and their carers  Open

DARS (Dopamine Augmented Rehabilitation in Stroke)
There is promising evidence suggesting that combining certain drugs such as Co-careldopa with physical and occupational therapy may improve the recovery of arm and leg movement and lead to improved function. A key aspect of this benefit is likely to stem from linking the timing of taking the co-careldopa medication with the therapy session. DARS is the world’s first large scale multicentre study to investigate the impact of combining Co-Careldopa with routine occupational and physical therapy in people with stroke enhances the effect of this routine therapy and improves the person’s ability to relearn essential day to day activities such as walking and dressing. The trial is currently recruiting well across more than 50 sites in the UK and we anticipate that the results will be available in Autumn 2015.

LoTSCare Longer Term Stroke Care
The longer-term consequences of stroke are well documented yet services addressing these needs are poorly developed. Community-based post stroke care has the potential to assess, support, and coordinate relevant services, and might be more helpful in minimizing longer-term stroke morbidity. LoTSCare is a cluster randomised trial which evaluated an evidence-based system of care delivered by stroke care Co-ordinators that aims to meet the longer-term needs for stroke survivors and their carers living at home in the community when compared to usual practice.

Recruitment of the target 800 patients and 200 carers was achieved in March 2011. Results have been analysed and will be published in late 2013

Related publications:
Forster, A., Young, J., Nixon, J., Chapman, K., Murray, J., Patel, A., Knapp, M., Anwar, S., Breen, R., Mellish, K., Holloway, I. and Farrin, A. (2013), Protocol of a cluster randomized trial evaluation of a patient and carer-centered system of longer-term stroke care (LoTS care). International Journal of Stroke. doi: 10.1111/ijs.12038

TRACS Training Caregivers after Stroke
The majority of stroke patients are discharged home dependent on informal caregivers, usually family members, to provide assistance with activities of daily living, including bathing, dressing, and toileting. Many caregivers feel unprepared for this role, and this may have a detrimental effect on both the patient and caregiver. TRACS is a cluster randomised trial which evaluated whether a structured, competency-based training programme for caregivers improves physical and psychological outcomes for patients and their caregivers after disabling stroke.

TRACS has successfully completed recruitment with a total of 930 patients and their carers, making it the world’s largest stroke rehabilitation trial to date. The results have recently been published in The Lancet.

Related publications:

Forster, A., Dickerson J., Young, J., Patel, A., Kalra, L., Nixon, J., Smithard, D., Knapp, M., Holoway, I., Anwar, S., Farrin, A. on behalf of the TRACS Trial Collaboration (2013). A structured training programme for caregivers of inpatients after stroke (TRACS): a cluster randomised controlled trial and cost-effectiveness analysis. The Lancet, Early Online Publication, 18 September 2013, doi:10.1016/S0140-6736(13)61603-7

Forster, A., Young, J., Nixon, J., Kalra, L., Smithard, D., Patel, A., Knapp, M., Monaghan, J., Breen, R., Anwar, S. and Farrin, A. (2012). A cluster randomized controlled trial of a structured training programme for caregivers of inpatients after stroke (TRACS). International Journal of Stroke, 7: 94–99. doi: 10.1111/j.1747-4949.2011.00722.x