Research focuses on improving outcomes for victims of stroke

Media Release

Research focuses on improving outcomes for victims of a stroke

The Health Research Council of New Zealand (HRC) has today announced a $74.56 million funding investment into health research, including three projects which will investigate new ways of prescribing and supporting rehabilitation following a stroke.

“Stroke is a leading cause of adult disability and is the second most common cause of death worldwide, representing a significant burden on families and the healthcare sector,” says HRC Chief Executive, Dr Robin Olds. “Therefore, we have an interest in supporting research on cost-effective interventions that will improve outcomes for those affected.”

Transient Ischaemic Attacks (TIAs), in which the blood supply to the brain is temporarily disrupted, commonly precede a stroke. Research has shown that receiving appropriate medical treatment within 24 hours of a TIA can reduce the risk of a stroke in the next three months by 80 per cent. The TIA/Stroke Electronic Decision Support (EDS) tool is designed to help GPs to realise this potential risk reduction through identifying high-risk patients and treating them early.

Developed by the MidCentral District Health Board Stroke Service in collaboration with the Best Practice Advocacy Centre Inc., EDS aids GPs in identifying TIAs accurately and initiating treatment immediately – without waiting for a specialist review. The tool also ensures practitioners are using current best-practice guidelines for the treatment of TIAs in New Zealand.

Dr Annemarei Ranta from the University of Otago, Wellington, aims to test the efficacy of the EDS tool with regard to stroke reduction, assess any risks associated with EDS use, and establish costs of EDS use compared with usual management.

The degree of functional impairment that an individual suffers following a stroke is partly dependent on how quickly an appropriate rehabilitation programme is initiated, and partly by the degree of damage that has been inflicted on the brain. Dr Cathy Stinear from The University of Auckland and a team of clinicians, scientists and economists will evaluate the benefits of a new process for prescribing rehabilitation after stroke, called ‘Targeted Rehabilitation, Improved Outcomes’ (TRIO).

TRIO combines information from bedside tests that indicate the degree and strength of movement in the affected limbs, and the extent that brain is capable of transmitting impulses to nerve pathways on the affected side of the body. Through combining this information, TRIO can predict the success of rehabilitation strategies in a given patient. Being able to objectively predict the degree of functionality that a patient is likely to recover means that rehabilitation can be tailored to individual needs. Intensive rehabilitation can be targeted to patients that have a good chance of recovery, and less gruelling regimens prescribed for patients who are likely to achieve the same result with fewer sessions.

Based on the degree of damage, individualised prescriptions can be developed that will give each patient the best outcomes possible, and may involve placing a greater emphasis on recovering speech than limb strength. The result would be more cost-effective use of scarce resources and better outcomes.

A trial by Dr Denise Taylor from AUT University will determine if the Augmented Community Telerehabilitation Intervention (ACTIV) helps people with stroke in the transition from rehabilitation support to independence and results in better outcomes and quality of life. ACTIV is a low-cost intervention delivered through telephone and mobile phones, combined with face-to-face visits from a physiotherapist. The research team will examine experiences of the intervention and the cost-effectiveness of providing it in future. In New Zealand, around 45,000 people live with stroke and benefits gained during initial rehabilitation are often not sustained, with a resultant functional deterioration and reduction in quality of life over time. Evidence indicates that participation in physical interventions prevents this functional decline but whether an individual receives ongoing stroke services is often related to factors such as resource availability and geographical location. The benefits of providing support via cheap and available technology are obvious.

In 2009, the HRC funded a study by Professor Valery Feigin from AUT University to find out the frequency of Traumatic Brain Injury (TBI) in a nationally representative population and to follow-up all patients over six-months to explore the effects of TBI.

The original study was based on published estimates of the size of the problem. However, halfway through recruitment, the actual number of cases of TBI in the study was 34 per cent higher than anticipated, highlighting the importance of this study. This year the HRC has funded another project by Professor Feigin, which aims to ensure that the additional cases are identified and assessed, to capture accurate incidence rates per annum, and to complete a further follow-up assessment at 12-months for all of the study. The year following a brain injury has been revealed as the critical recovery period, therefore it is important to follow patients up to 12-months post injury to obtain a realistic picture of outcomes and burden of TBI.

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