Stroke Research and Treatment最新文献

{"title":"Prevalence of Stroke and Associated Risk Factors in Sleman District of Yogyakarta Special Region, Indonesia.","authors":"Ismail Setyopranoto, Halwan Fuad Bayuangga, Andre Stefanus Panggabean, Sarastiti Alifaningdyah, Lutfan Lazuardi, Fatwa Sari Tetra Dewi, Rusdy Ghazali Malueka","doi":"10.1155/2019/2642458","DOIUrl":"10.1155/2019/2642458","url":null,"abstract":"<p><strong>Background: </strong>Stroke remains one of the most common noncommunicable diseases among Indonesian populations. This study aimed to identify the prevalence of stroke and its associated risk factors in the Sleman District of Yogyakarta Special Region, Indonesia.</p><p><strong>Method: </strong>This study was a secondary analysis of community-based data collected by the Sleman Health and Demographic Surveillance System (HDSS) in 2016. Basic demographic and socioeconomic data were collected. Additional questions about history of stroke and other chronic diseases were interviewed as a self-reported diagnosis. History of hormonal contraceptives use and dietary patterns were also collected. We examined the association between the prevalence of stroke and risk factors, namely, age, gender, self-reported history of chronic diseases, hormonal contraceptives use, and high-risk dietary patterns.</p><p><strong>Results: </strong>The survey included 4,996 households composed of 20,465 individuals. Data regarding stroke incidents were available from 13,605 subjects aged ≥20 years old. Among them, a total of 4,884 subjects also have data regarding stroke risk factors. The overall prevalence of stroke in Sleman District was 1.4% (0.5% men and 0.90% women). The prevalence increased with additional decades of age (<i>p</i><0.001). In a multivariable model, increasing age, self-reported history of hypertension (OR=8.37, 95%CI: 4.76 to 14.69), and self-reported history of diabetes mellitus (OR=2.87, 95%CI: 1.54 to 5.35) were significantly associated with stroke.</p><p><strong>Conclusions: </strong>A community-based survey in Indonesia showed a high prevalence of stroke which was associated with increasing age, hypertension, and diabetes mellitus. These findings suggest that preventive actions against the aforementioned modifiable risk factors should be prioritized.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2019 ","pages":"2642458"},"PeriodicalIF":1.8,"publicationDate":"2019-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37323257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive and Emotional Impairment after Minor Stroke and Non-ST-Elevation Myocardial Infarction (NSTEMI): A Prevalence Study.","authors":"Åse Hagen Morsund,&nbsp;Hanne Ellekjær,&nbsp;Arne Gramstad,&nbsp;Magnus Tallaksen Reiestad,&nbsp;Rune Midgard,&nbsp;Sigrid Botne Sando,&nbsp;Egil Jonsbu,&nbsp;Halvor Næss","doi":"10.1155/2019/2527384","DOIUrl":"https://doi.org/10.1155/2019/2527384","url":null,"abstract":"<p><strong>Aim: </strong>To study the prevalence of cognitive and emotional impairment following a minor ischemic stroke compared to an age-matched group with non-ST-elevation myocardial infarction (NSTEMI).</p><p><strong>Methods: </strong>We included patients aged 18-70 years with a minor ischemic stroke defined as modified Rankin Scale (mRS) 0-2 at day 7 or at discharge if before and age-matched NSTEMI patients with the same functional mRS. We applied a selection of cognitive tests and the patients completed a questionnaire comprising of Hospital Anxiety and Depression scale (HADS) and Fatigue Severity Scale (FSS) at follow-up 12 months after the vascular event. Results of cognitive tests were also compared to normative data.</p><p><strong>Results: </strong>325 ischemic stroke and 144 NSTEMI patients were included. There was no significant difference in cognitive functioning between ischemic stroke and NSTEMI patients. Minor stroke patients and to a lesser extent NSTEMI patients scored worse on more complex cognitive functions including planning and implementation of activities compared to validated normative data. For the minor stroke patients the location of the ischemic lesion had no influence on the result. The prevalence of anxiety, depression, and fatigue was significantly higher in the stroke group compared to the NSTEMI group. Depression was independently associated with reduced cognitive function.</p><p><strong>Discussion and conclusion: </strong>Minor ischemic stroke patients, and to lesser degree NSTEMI patients, had reduced cognitive function compared to normative data, especially executive functioning, on 12-month follow-up. The difference in cognitive function between stroke and NSTEMI patients was not significant. Depression was associated with low scores on cognitive tests highlighting the need to adequately address emotional sequelae when considering treatment options for cognitive disabilities.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2019 ","pages":"2527384"},"PeriodicalIF":1.5,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/2527384","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37212721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood Flow Assessment of Arteriovenous Malformations Using Intraoperative Indocyanine Green Videoangiography.","authors":"Naoki Kato,&nbsp;Vincent Prinz,&nbsp;Julius Dengler,&nbsp;Peter Vajkoczy","doi":"10.1155/2019/7292304","DOIUrl":"https://doi.org/10.1155/2019/7292304","url":null,"abstract":"<p><p>Intraoperative indocyanine green (ICG) videoangiography is widely used in patients undergoing neurosurgery. FLOW800 is a recently developed analytical tool for ICG videoangiography to assess semi-quantitative flow dynamics; however, its efficacy is unknown. In this study, we evaluated its functionality in the assessment of flow dynamics of arteriovenous malformation (AVM) through ICG videoangiography under clinical settings. ICG videoangiography was performed in the exposed AVM in eight patients undergoing surgery. FLOW800 analysis was applied directly, and gray-scale and color-coded maps of the surgical field were obtained. After surgery, a region of interest was placed on the individual vessels to obtain time-intensity curves. Parameters of flow dynamics, including the maximum intensity, transit time, and cerebral blood flow index, were calculated using the curves. The color-coded maps provided high-resolution images; however, reconstruction of colored images was restricted by the depth, approach angle, and brain swelling. Semi-quantitative parameters were similar among the feeders, niduses, and drainers. However, a higher cerebral blood flow index was observed in the feeders of large AVM (>3 cm) than in those of small AVM (P < 0.05). Similarly, the cerebral blood flow index values were positively correlated with the nidus volume (P < 0.01). FLOW800 enabled visualization of the AVM structure and safer resection, except in case of deep-seated AVM. Moreover, semi-quantitative values in the individual vessels through using ICG intensity diagram showed different patterns according to size of the AVM. ICG videoangiography showed good performance in evaluating flow dynamics of the AVM in patients undergoing surgery.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2019 ","pages":"7292304"},"PeriodicalIF":1.5,"publicationDate":"2019-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/7292304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37171751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke Event Factors among Adult Patients Admitted to Stroke Unit of Jimma University Medical Center: Prospective Observational Study.","authors":"Ginenus Fekadu,&nbsp;Hunduma Wakassa,&nbsp;Firew Tekle","doi":"10.1155/2019/4650104","DOIUrl":"https://doi.org/10.1155/2019/4650104","url":null,"abstract":"<p><strong>Background: </strong>The fact that the majority of patients come late creates management difficulties as these first hours are important to avoid secondary insults to the brain and preserve the ischemic penumbra. Although thrombolytic treatments are currently not available in our hospital, significant delays during the prehospital or in-hospital phases of care create management difficulties and would make such advanced treatments impossible in the future in Ethiopia.</p><p><strong>Methods: </strong>Prospective observational study was carried at stroke unit of Jimma University Medical Center for 4 consecutive months from March 10 to July 10, 2017. Data was cleaned and entered to Epidata version 3.1 and then exported and analyzed using SPSS version 20.0.</p><p><strong>Results: </strong>A total of 116 eligible stroke patients were recruited during the study period with mean age of 55.1±14.0 years, ranging from 23 to 96 years. The majority of stroke patients were males (62.9%) and from rural areas (72.4%). The median time elapsed between the onset of stroke symptoms and arrival to the hospital was 27 hours. Almost half (47.4%) of the patients presented within 24 hours and 26 (22.4%) patients presented to hospital beyond 72 hours. Majority of patients (40.5%) showed severe neurological deficit on admission and the mean National Institute of health stroke scale (NIHSS) was 15.71 ± 7.52. The mean Glasgow coma scale (GCS) was moderate (12.12±3.35). On hospital arrival systolic blood pressure (SBP) was highly elevated (≥140 mm Hg) in 65.5% of the patients. The circadian pattern showed a significant peak in morning for hemorrhagic stroke (35.7%) and afternoon for ischemic stroke (38.3%).</p><p><strong>Conclusions: </strong>The delay of hospital arrival was a challenge similar to other high income countries for early management of the patients. Studies that attempt to determine some of the factors that impede timely presentation in patients with strokes are advisable to address those issues further.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2019 ","pages":"4650104"},"PeriodicalIF":1.5,"publicationDate":"2019-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/4650104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37042342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Hospital Mortality among Ischemic Stroke Patients in Gondar University Hospital: A Retrospective Cohort Study.","authors":"Eyob Alemayehu Gebreyohannes,&nbsp;Akshaya Srikanth Bhagavathula,&nbsp;Tamrat Befekadu Abebe,&nbsp;Mohammed Assen Seid,&nbsp;Kaleab Taye Haile","doi":"10.1155/2019/7275063","DOIUrl":"https://doi.org/10.1155/2019/7275063","url":null,"abstract":"<p><strong>Introduction: </strong>Ischemic stroke is the third leading cause of mortality in low-income countries and the sixth in Ethiopia. The aim of this study was to determine the rate and predictors of in-hospital mortality due to ischemic stroke in Gondar University Hospital.</p><p><strong>Methods: </strong>The study was conducted from April 1, 2017, to May 15, 2017, at Gondar University Hospital. A census using retrospective cohort study design was conducted on medical records of adult patients with the diagnosis of ischemic stroke attending the medical inpatient ward of Gondar University Hospital between November 2012 and September 2016. Cox hazard regression was used to determine the predictors of in-hospital mortality. A two-sided statistical test at 5% level of significance was used.</p><p><strong>Results: </strong>The mean (±SD) duration of hospital stay was 11.55 (10.040) days. Of the total 208 patients, 26 (12.5%) patients died in the hospital. Cox regression revealed that only a decrease in renal function, particularly elevated serum creatinine (AHR=8.848, 95% CI: 1.616-67.437), was associated with a statistically significant increase of in-hospital mortality. The symptom onset-to-admission time varied greatly among patients and ranged from 1 hour to 168 hours.</p><p><strong>Conclusion: </strong>The in-hospital mortality associated with ischemic stroke was found to be high. Mainly, elevation in serum creatinine was highly associated with poorer outcomes in terms of in-hospital mortality. Much work should be done on improving the knowledge and awareness of the community regarding ischemic stroke and stroke in general to encourage early medical seeking behavior and reduce mortality and long-term disability.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2019 ","pages":"7275063"},"PeriodicalIF":1.5,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2019/7275063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36906378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Ischaemic Stroke Subtype on 30-day Hospital Readmissions.","authors":"Anna Therese Bjerkreim,&nbsp;Andrej Netland Khanevski,&nbsp;Henriette Aurora Selvik,&nbsp;Ulrike Waje-Andreassen,&nbsp;Lars Thomassen,&nbsp;Halvor Naess,&nbsp;Nicola Logallo","doi":"10.1155/2018/7195369","DOIUrl":"https://doi.org/10.1155/2018/7195369","url":null,"abstract":"<p><strong>Background: </strong>Stroke aetiology may affect the risk and causes of readmission after ischaemic stroke (IS) and transient ischaemic attack (TIA) due to differences in risk factors, functional outcome, and treatment. We aimed to examine frequencies, causes, and risk of 30-day readmission by stroke subtype, determine predictors of 30-day readmission, and study the impact of 30-day readmissions on one-year mortality.</p><p><strong>Methods: </strong>All surviving patients admitted with IS or TIA from July 2007 to December 2013 were followed by review of medical records for all unplanned readmissions within 30 days after discharge. Stroke subtype was classified as large-artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other determined aetiology (SOE), or stroke of undetermined aetiology (SUE). Cox regression analyses were performed to assess the risk of 30-day readmission for the stroke subtypes and identify predictors of 30-day readmission, and its impact on one-year mortality.</p><p><strong>Results: </strong>Of 1874 patients, 200 (10.7%) were readmitted within 30 days [LAA 42/244 (17.2%), CE 75/605 (12.4%), SVO 12/205 (5.9%), SOE 6/32 (18.8%), SUE 65/788 (8.3%)]. The most frequent causes of readmissions were stroke-related event, infection, recurrent stroke/ TIA, and cardiac disease. After adjusting for age, sex, functional outcome, length of stay, and the risk factor burden, patients with LAA and SOE subtype had significantly higher risks of readmission for any cause, recurrent stroke or TIA, and stroke-related events. Predictors of 30-day readmission were higher age, peripheral arterial disease, enteral feeding, and LAA subtype. Thirty-day readmission was an independent predictor of one-year mortality.</p><p><strong>Conclusions: </strong>Patients with LAA or SOE have a high risk of 30-day readmission, possibly caused by an increased risk of recurrent stroke and stroke-related events. Awareness of the risk of readmission for different causes and appropriate handling according to stroke subtype may be useful for preventing some readmissions after stroke.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"7195369"},"PeriodicalIF":1.5,"publicationDate":"2018-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/7195369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36865129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke in the 21^st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life.","authors":"Eric S Donkor","doi":"10.1155/2018/3238165","DOIUrl":"https://doi.org/10.1155/2018/3238165","url":null,"abstract":"<p><p>Stroke is ranked as the second leading cause of death worldwide with an annual mortality rate of about 5.5 million. Not only does the burden of stroke lie in the high mortality but the high morbidity also results in up to 50% of survivors being chronically disabled. Thus stroke is a disease of immense public health importance with serious economic and social consequences. The public health burden of stroke is set to rise over future decades because of demographic transitions of populations, particularly in developing countries. This paper provides an overview of stroke in the 21^st century from a public health perspective.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"3238165"},"PeriodicalIF":1.5,"publicationDate":"2018-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/3238165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36824872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TOAST Subtypes of Ischemic Stroke and Its Risk Factors: A Hospital-Based Study at Cipto Mangunkusumo Hospital, Indonesia.","authors":"Salim Harris,&nbsp;Saleha Sungkar,&nbsp;Al Rasyid,&nbsp;Mohammad Kurniawan,&nbsp;Taufik Mesiano,&nbsp;Rakhmad Hidayat","doi":"10.1155/2018/9589831","DOIUrl":"10.1155/2018/9589831","url":null,"abstract":"<p><strong>Background and purpose: </strong>Stroke is a leading cause of death and disability, with ischemic stroke as the highest prevalent cases in Indonesia. Ischemic stroke can be classified further into five subtypes according to TOAST classification. Numerous studies have revealed that stroke risk factor has variable correlation with different stroke subtype. Currently, there is no data regarding this phenomenon in Indonesia. The aim of study is to identify characteristic of ischemic stroke subtypes and the risk factors in TOAST classification.</p><p><strong>Methods: </strong>A retrospective, cross-sectional study of patients diagnosed with ischemic stroke at Cipto Mangunkusumo Hospital from January till December 2016. Demographic data, ischemic stroke subtypes, risk factors, and other relevant data were documented. Bivariate and multivariate analysis was done using SPSS 23.</p><p><strong>Results: </strong>235 recorded data patients were included. Large artery atherosclerosis (LAA) was the most prevalent stroke subtypes at 59,6%, followed with small vessel disease (SVD) at 26,7%, undetermined etiology at 9,8%, cardioembolism (CE) at 2,1%, and other determined etiology at 0,9%. Hypertension was the most common vascular risk factor. However, it was only significant in SVD (p=0,023) and undetermined etiology subtypes (p<0,001). Significant risk factor in LAA was diabetes (55%; p=0,016) while in CE subtypes was atrial fibrillation (60%;p<0,001). In multivariate analyses, hypertension (OR 3; 95% CI 1,12-8,05) was the only variable that was related to SVD while in CE it was atrial fibrillation (OR 113,5; 95% CI 13,6-946,5).</p><p><strong>Conclusion: </strong>LAA was the most common stroke ischemic subtypes. Associated risk factor in LAA was diabetes while in SVD and undetermined etiology subtypes it was hypertension. Atrial fibrillation was associated with cardioembolism.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"9589831"},"PeriodicalIF":1.5,"publicationDate":"2018-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/9589831","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36757700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical Thrombectomy by a Direct Aspiration First Pass Technique (ADAPT) in Ischemic Stroke: Results of Monocentric Study Based on Multimodal CT Patient Selection.","authors":"Giuseppe Guzzardi,&nbsp;Bruno Del Sette,&nbsp;Carmelo Stanca,&nbsp;Andrea Galbiati,&nbsp;Massimiliano Cernigliaro,&nbsp;Alessandro Carriero,&nbsp;Alessandro Stecco","doi":"10.1155/2018/6192483","DOIUrl":"https://doi.org/10.1155/2018/6192483","url":null,"abstract":"<p><strong>Introduction: </strong>Mechanical thrombectomy with ADAP-technique of ischemic stroke has been reported as fast and effective. Aim of this study is to evaluate imaging criteria as possible predictors of stroke severity, therapeutic success, and outcome.</p><p><strong>Materials and methods: </strong>Patients (30) presenting from October 2015 to April 2017 with Emergent Large Vessel Occlusion of the anterior circulation were treated with ADAP-technique. 22 received also IV tPA; 8 underwent endovascular treatment only. Every patient was evaluated with noncontrast CT, multiphase angiography-CT, and perfusion CT. Clinical and radiological characteristics were measured. Good clinical outcome was an improvement of 8 points on NIHSS at discharge or a modified Rankin Scale ≤2 at discharge and at 90 days.</p><p><strong>Results: </strong>Successful revascularization was obtained in 57% of patients, no procedural complications were witnessed, and only two hemorrhages were reported. Good outcome at discharge was obtained in 11 patients (37%) and predicted by NCCT ASPECT and TICI; outcome at 90 days was predicted by NCCT ASPECT, clot length, and premorbid mRS. Mortality was 23% at discharge and 30% at 90 days.</p><p><strong>Conclusion: </strong>ADAPT is an effective endovascular method of stroke treatment with fast procedural times. Multimodal CT evaluation is effective in assessing stroke severity, providing important prognostic information, which is able to select patients for the appropriate treatment.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"6192483"},"PeriodicalIF":1.5,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/6192483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36741039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale for Intervention and Dose Is Lacking in Stroke Recovery Trials: A Systematic Review.","authors":"Karen Borschmann, Kathryn S Hayward, Audrey Raffelt, Leonid Churilov, Sharon Kramer, Julie Bernhardt","doi":"10.1155/2018/8087372","DOIUrl":"10.1155/2018/8087372","url":null,"abstract":"<p><strong>Background: </strong>The ineffectiveness of most complex stroke recovery trials may be explained by inadequate intervention design. The primary aim of this review was to explore the rationales given for interventions and dose in stroke rehabilitation randomised controlled trials (RCTs).</p><p><strong>Methods: </strong>We searched the Cochrane Stroke Group library for RCTs that met the following criteria: (1) training based intervention; (2) >50% participants who were stroke survivors; (3) full peer-reviewed text; (4) English language. We extracted data on 16 quality items covering intervention dose (n= 3), trial design (n= 10), and risk of bias (n= 3) and 18 items related to trial method. Logistic regression analyses were performed to determine whether (1) reporting of trial quality items changed over time; (2) reporting of quality items was associated with the likelihood of a positive trial, adjusted for sample size and number of outcomes.</p><p><strong>Results: </strong>27 Cochrane reviews were included, containing 9,044 participants from 194 trials. Publication dates were 1979 to 2013, sample size was median 32 (IQR 20,58), and primary outcome was reported in 49 trials (25%). The median total quality score was 4 (IQR 3,6) and improved significantly each year (OR 1.12, 95% CI 1.07, 1.16, p<0.001). Total quality score was not associated with likelihood of a positive trial, but trials containing a biological rationale for the intervention were more likely to find a difference in patient outcome (OR 2.18, 95% CI 1.14, 4.19, p=0.02).</p><p><strong>Conclusion: </strong>To develop breakthrough treatments we need to build the rationale for research interventions and testing of intervention dosage. This will be achieved through a collective research agenda to understand the mechanistic principles that drive recovery and identification of clearer targets for clinical trials.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"8087372"},"PeriodicalIF":1.5,"publicationDate":"2018-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36741040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}