Stroke Specialty Profile
Delivering stroke research in the UK
The UK has a unique research infrastructure set up to deliver stroke studies with a network of hospitals, including most acute hospitals in the UK. The NIHR Clinical Research Network (CRN) provides local researchers with the practical support they need to make research happen in our National Health Service (NHS). As well as providing research delivery staff, we also bring together communities of clinical practice to provide national networks of research expertise.
The Stroke Specialty is one of 30 such communities and is made up of leading research-interested clinicians and practitioners at both national and local levels. Our job is to ensure that the stroke studies we support are delivered to time and target. We cover the entire stroke pathway, from the first few hours after stroke, until months and years later. Patients with stroke present to all healthcare settings and we can seamlessly access them all, from primary care to specialist hospitals. Research areas of focus in stroke have included hyperacute, recovery, rehabilitation and prevention. We are currently delivering trials testing novel clot retrieval devices, drugs for the treatment of stroke, stem cell therapies and robotics to help recovery after stroke. We can provide:
Specialty group membership is made up of key opinion leaders across the UK with specific skills and expertise. In addition there are principal investigators working on National Institute for Health Research (NIHR) Portfolio Stroke Specialty studies at 236 sites, spread over 115 acute trusts. In particular we have 11 hyperacute stroke research centres with an increased support infrastructure to deliver complex interventions within the first nine hours of stroke onset. This includes drugs and device studies.
Access to patients
Over 15,000 participants with stroke were recruited into trials on the NIHR Clinical Research Network portfolio in 2017/18 (approximately 15 percent of the hospital-admitted stroke population). We can support study teams and commercial partners with access to a range of patient populations. Our patient involvement strategy is engaging patient groups and strengthening our capacity to enable people with communication or cognitive problems, both common after stroke, to participate in research. We have a strong track record of recruiting participants in the emergency setting of hyperacute stroke. We can provide advice and guidance on recruitment strategies and approaches to overcoming potential barriers to successful study delivery. We can provide accurate feasibility data based on the Stroke Sentinel National Audit Programme with respect to hospital admissions and the track record of sites in recruiting to similar studies in the past.
The CRN Stroke specialty support and oversee a wide range of studies; from single-centre early stage evaluation of a medical technology, through to larger multi-centre observational studies and randomised controlled trials of medical, neuro-interventional and surgical treatments. We provide a network of potential investigators amongst which basic study information can be rapidly disseminated. We can provide accurate information about the delivery capabilities of potential study sites, allowing you to select suitable study locations. The Network enables calls for more sites or study participants to be made quickly and easily, and we can draw on expertise to resolve any issues that might occur in your study.
Collaboration with other clinical specialties is integral to service delivery and research into stroke. We work closely with other specialties, such as: Cardiovascular, Injuries and emergencies, Haematology, Primary care, and Dementias and Neurodegeneration. This provides access to support and expertise which helps to maximise opportunities for recruitment of study participants. Stroke research is undertaken not only by stroke physicians, but also allied health professionals such as: physiotherapists, occupational therapists, psychologists, speech and language therapists, paramedics and stroke research nurses. Through the NIHR Clinical Research Network you can rapidly access the most appropriate professionals to carry out your trial.
GORE - The Gore Reduce Clinical Study
• UK recruitment target 12
• UK participants recruited 31 The aim of the GORE study was to investigate a percutaneous cardiac closure device for the secondary prevention of stroke in younger people. The NIHR CRN supported recruitment of patients with ischaemic stroke secondary to an underlying cardiac defect from four stroke units across the UK. Following identification and specialist stroke work up, eligible participants were randomised to either percutanoues closure device (or standard care) by the cardiologist. This trial was complex as it required collaboration between acute stroke services and cardiology, NIHR support for identification, enrolment and follow-up across both specialties was key in this study exceeding its target recruitment by 200 per cent.
STEPS - A Study of Swallowing Treatment using Electrical Pharyngeal Stimulation
• Global recruitment target 140
• UK recruitment target 24
• UK participants recruited 102 Swallowing problems are common after stroke and a proportion of survivors are left dependent on feeding tubes. The STEPS study investigated electrical stimulation, applied to the pharynx by a device similar to a feeding tube. Assessment and treatment of swallowing is dependent on multi-disciplinary skills, including doctors nurses and speech and language therapists. The NIHR CRN supported research staff from these multi-disciplinary teams to deliver the STEPS study in 11 stroke units across the UK, with 102 participants recruited over 26 months, making this the largest trial of its kind worldwide.
Find out more
You can visit our website at: www.nihr.ac.uk/stroke
Access our Study Support Service
Phone: 00 44 113 34 34 555