What is the impact of large-scale implementation of stroke Early Supported Discharge? (WISE) study
NIHR Health Services & Delivery Research
The three-year study will investigate the implementation and effectiveness of stroke Early Supported Discharge services across England. It involves a collaboration with the Royal College of Physicians’ Sentinel Stroke National Audit Programme and a world class team of co-applicants from Nottingham, Leicester and Glasgow. The aim is to facilitate provision of evidence based care for stroke survivors leaving hospital.
Project Lead: Dr Rebecca Fisher
Co-Investigators: Professor Marion Walker, Professor Sarah Lewis, Professor Justin Waring, Dr Claudia Geue, Professor Peter Langhorne, Professor Tom Robinson, Alex Hoffman, Prof Tony Rudd
Return to work after stroke (RETAKE)
The RETAKE study is a four-year study that aims to determine whether early stroke specific vocational rehabilitation (ESSVR) in addition to usual NHS rehabilitation (UC) is more effective and cost effective at returning stroke survivors to work and keeping them there at 12 months post-randomisation than UC alone.
Biopsychosocial Intervention for Stroke Carers (BISC study)
The aim of the BISC study is to evaluate whether a group intervention offering support and education based on biopsychosocial principles improves adjustment and mood outcomes in carers of stroke survivors.
Project Lead: Professor Marion Walker
Co-Investigators: Dr Rebecca Fisher, Dr Penny Benford, Dr Eirini Kontou, Dr Shirley Thomas, Dr Joanna Fletcher-Smith
Visit the BISC webpage
Electrical Stimulation to prevent Complications in the Arm Post-Stroke (ESCAPS) - A feasibility study
The ESCAPS study will evaluate the feasibility of running a definitive trial to ascertain the efficacy of using early, intensive ES therapy to prevent post stroke complications in the affected arm. The qualitative aspect of the feasibility study will explore possible barriers and facilitators to protocol adherence.
Project Lead: Dr Joanna Fletcher-Smith
Visit the ESCAPS webpage
Behavioural Activation therapy for Depression after Stroke (BEADS)
This is a pilot randomised controlled trial to assess the feasibility of a study to investigate the clinical and cost-effectiveness of behavioural activation (BA) therapy for people with post-stroke depression.
Project Lead: Dr Shirley Thomas and the Trial is being coordinated from the Sheffield Clinical Trials Research Unit.
Visit the BEADS webpage
Recently completed projects, or in the writing-up stage
FAmily-Led RehabiliTaTion aftEr Stroke in INDia - The ATTEND Trial
The primary aim of the study is to determine whether stroke recovery at home given by a trained family member is an effective, affordable strategy for those with disabling stroke in India when compared to usual care.
Secondary aims are to determine if Early Supported Discharge with a trained family-led caregiver-delivered, home-based rehabilitation program reduces hospital length of stay; reduces death or dependency (as measured by scores of three to six on the modified Rankin Scale) of people with stroke three months after randomisation; improves patient and caregiver mood at six months; and reduces caregiver burden.
Chief Investigator: Richard Lindley
Local Project Lead: Professor Marion Walker
Read more about this trial.
Research to Implement EVidence Based In-Hospital Stroke Rehabilitation (REVIHR) study (CLAHRC)
East Midlands CLAHRC - Caring for Older People and Stroke Survivors Theme (COPPS)
The aims of this study are to develop a change intervention designed to facilitate the delivery of evidence based stroke rehabilitation in hospitals across the East Midlands.
Project Lead: Professor Marion Walker
Co-Investigators: Dr Rebecca Fisher, Dr Laura Condon, Dr Eirini Kontou, Dr Shirley Thomas, Dr Joanna Fletcher-Smith, Dr Penny Benford
A theory-driven research approach will be used. Behavioural mapping will be conducted in hospital sites to examine how the delivery of rehabilitative care relates to national stroke audit scores and evidence based guidelines. Qualitative research will be conducted, using a case study approach at each site, to identify challenges faced. Realistic evaluation will provide a framework to explore interactions between the context and service organisation that influence the rehabilitation that patients receive. Findings will be used to develop a change intervention, in collaboration with stakeholders, that will be piloted in several sites.
Find out how to get involved with CLAHRC in the East Midlands
Successful implementation of Early Supported Discharge Services
This research programme investigated the implementation of Stroke Early Supported Discharge. The aim was to investigate whether the health benefits identified in clinical trials were still evident when Early Supported Discharge services were implemented into local areas. [Project leads: Dr Rebecca Fisher, Prof Marion Walker)
NIHR CLAHRC Nottinghamshire, Derbyshire and Lincolnshire (2009−2013)
Stroke Early Supported Discharge is a multidisciplinary team intervention that clinical trials have shown reduces length of hospital stay and reduces risk of death and dependency. In 2009, many stroke services in the UK were in the process of implementing Early Supported Discharge Services as a result of the National Stroke Strategy 2007. This research aimed to gain clarity around how an Early Supported Discharge service might be organised in practice, test methods to facilitate its implementation and test methods to measure the effectiveness of Early Supported Discharge services.
Consensus on the definition of Early Supported Discharge Services
An agreed definition of Early Supported Discharge following stroke was established amongst all Early Supported Discharge trialists. Consensus was then gained amongst researchers and clinicians on the implementation of community stroke rehabilitation services.
A Consensus on Stroke Early Supported Discharge. Stroke. 2011; 42:1392-1397.
The implementation of evidence based rehabilitation services for stroke survivors living in the community. The results of a Delphi consensus process. Clinical Rehabilitation 2013. 27(8): 741-749
Mapping Early Supported Discharge Services
Semi-structured interviews were completed with stakeholders, commissioners, service providers and allied healthcare professionals to understand the factors influencing the development, organisation and implementation of Early Supported Discharge services in the Nottinghamshire and Northamptonshire regions. Face-to-face interviews were also conducted with patients and their carers.
Implementing evidence-based Stroke Early Supported Discharge services: a qualitative study of challenges, facilitators and impact. Clinical Rehabilitation. 2014. 28(4):370-377
A qualitative study exploring patients’ and carers’ experiences of Early Supported Discharge Services after stroke. Clinical Rehabilitation. 2013. 27(8): 750-757
The research team designed and delivered interactive workshops focused on ‘Eligibility for Early Supported Discharge’ and ‘Effective Data handling’ to facilitate evidence based practice.
Implementation of Early Supported Discharge: expectation not icing on the cake.
Evaluation of ESD services: the utility of routine data
Measuring the effectiveness of Early Supported Discharge Services
Two Early Supported Discharge services operating in practice were evaluated; both services had adopted an evidence model (based on consensus documents). Stroke survivors who accessed the evidence based Early Supported Discharge services had significantly shorter length of hospital stay and accelerated improvement in activities of daily living compared to stroke survivors who didn’t access Early Supported Discharge.
Is Stroke Early Supported Discharge still effective in practice? A prospective comparative study. Clinical Rehabilitation. 2015 Mar 31. pii: 0269215515578697
Improving community stroke services across the East Midlands (2013−2015)
This NIHR CLAHRC research informed a two year programme of service improvement activities designed to facilitate the provision of evidence based community stroke care across the East Midlands. Commissioned by the East midlands Academic Health Science Network, this programme involves commissioner support, alignment of performance metrics, delivery of a multidisciplinary team effectiveness programme and improved information provision for stroke survivors. For more information: http://emahsn.org.uk/programmes-and-projects/stroke-rehabilitation/
Dressing Rehabilitation Evaluation Stroke Study (DRESS)
A trial to compare a neuropsychological approach to dressing, with the conventional approach commonly used by occupational therapists in the UK. (Project lead: Professor Marion Walker)
Getting out of the house after stroke
A randomised controlled trial to test if an occupational therapy treatment package could be used to overcome the problems faced by people with stroke who cannot get out of the house. (Project Lead: Prof Pip Logan)
Communication and Low Mood
A multicentre randomised controlled trial to evaluate whether a psychological treatment, called behaviour therapy, is effective at treating low mood in people with aphasia due to a stroke. (Project lead: Dr Shirley Thomas)
Evaluating the feasibility of using a modified Wii system in the home to assist in the rehabilitation of stroke patients with residual upper limb problems. (Project lead: Prof Penny Standen)
Return to work after stroke (Feasibility study)
Determining what people with stroke, their employers and other stakeholders want from vocational rehabilitation services, so that appropriate services can be designed. (Lead: Dr Kate Radford)
Predicting fitness to drive
Illustrating the simple tests which can be used to predict fitness to drive in people with dementia, multiple sclerosis, Parkinson's disease and stroke (Lead: Dr Kate Radford)
Home Visits After Stroke
Evaluating the feasibility of conducting a large multi centre randomised controlled trial of home visits conducted prior to discharge from hospital. (Lead: Prof Avril Drummond)
Granulocyte-Colony-Stimulating Factor Mobilizes Bone Marrow Stem Cells in Patients With Subacute Ischemic Stroke: The Stem Cell Trial of Recovery EnhanceMent After Stroke (STEMS)
Loss of motor function is common after stroke and leads to significant chronic disability. Stem cells are capable of self-renewal and of differentiating into multiple cell types, including neurones, glia, and vascular cells. The trial is assessing the safety of granulocyte-colony-stimulating factor (G-CSF) after stroke and its effect on circulating CD34+ stem cells. (Lead: Dr Niki Sprigg)
Chief Investigator: Dr Niki Sprigg
"Looped" naso-gastric feeding after stroke
Can looped nasogastric tube feeding improve feeding in people who can't swallow after a stroke? (Lead: Dr Niki Sprigg)