The NIHR is the nation's largest funder of health and care research and provides the people, facilities and technology that enable research to thrive. We work in partnership with the NHS, universities, local government, other research funders (including industry and charities), patients and the public to improve the health and wealth of the nation.
In 2017/18, the NIHR spent £9.9 million on research studies into stroke through our research programmes. Last year (2018/19) the NIHR Clinical Research Network (CRN) supported 118 studies on stroke, 36 of which were new, and recruited 20,963 patients to stroke studies.
INTERACT2 (Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial 2) was an international, multicentre, prospective, randomized, open-treatment, blinded end-point trial. The aim of the study was to determine the safety and effectiveness of early intensive lowering of blood pressure in patients with intracerebral haemorrhage, and whether it would improve patient outcomes.
The study found that early intensive lowering of blood pressure, compared with the recommended guidelines, did not result in a significant reduction in the rate of the primary outcome of death or major disability. However, the study did find there were significantly better functional outcomes among patients assigned to intensive treatment to lower their blood pressure than among patients assigned to guideline-recommended treatment.
The study was on the NIHR Clinical Research Network’s Portfolio and received NIHR infrastructure support, including research nurses, to deliver the study.
Whilst wider use of mechanical thrombectomy will have a significant impact on quality of life, research into use of the treatment doesn’t end here. Studies like STABILISE are looking into the efficacy and safety of a new device for thrombectomy, so that clinicians can maximise its use and patient benefits can continue to be realised.
A biosensor, called SMARTchip, has been designed to detect whether a person has had a stroke or not. The biosensor identifies an increase in the level of purines in the blood, believed to be an indicator of a stroke.
The SMARTchip has the potential to speed up diagnosis and reduce doubt, by supporting our clinical diagnostic skills and other tests. It is vital to act fast. Any indecision can increase the time it takes to assess the best course of action.
In 2013, the project received a £471,000 funding award from the NIHR Invention for Innovation Programme.
The support provided by the CRN was important to this study, as Dr Roffe explains: “You can’t run a study like this without the infrastructure and research nurses support the Network provides. This enabled us to deliver the study over three different sites across England.
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 Clinical Research Network 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 percutaneous 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.
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 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.
Immobile patients face a 10-20% risk of deep vein thrombosis (DVT) during the first month after stroke. The CLOTS – or ‘Clots in Legs Or sTockings after Stroke’ studies are testing graduated compression stockings for DVT prevention in acute stroke patients.
The study found that 200 patients would need to be fitted with thigh-length GCS to prevent one proximal DVT. Patients in the interventional group had significantly more problems with skin ulcers, blisters and ulceration.
As a result, NICE revised its stroke guidelines in early 2010, and no longer recommend thigh-length GCS for stroke patients.
The NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester created a tailored assessment tool to help determine the specific care needs for individual stroke patients, six months after their stroke.
The Greater Manchester Stroke Assessment Tool (GM-SAT) is a free, evidence-based assessment tool designed specifically for a six month post-stroke review. GM-SAT identifies a wide range of potential post-stroke care needs, from medication management and secondary prevention, through to mood and fatigue problems.
GM-SAT is now used across the country and is the only tool used for post-stroke assessment by the Stroke Association. They have carried out more than 12,500 assessments to date in areas where they are commissioned to do so, with the number of assessments having grown year on year since its introduction as shown in the table across.
You can find out more about research studies in your area through the Be Part of Research website.
Stroke is the fourth biggest killer in the United Kingdom, and a leading cause of disability. There are more than 100,000 strokes in the UK each year. Over 1.2 million people in the UK living with the consequences of stroke.
Stroke research matters. It has meant:
The NIHR provides researchers with the practical support they need to make clinical studies happen in the NHS. This support covers every stage of research, from set up to delivery.
We provide world-class health service infrastructure - research support staff such as clinical research nurses, and research support services such as pharmacy, pathology and radiology - to support organisations seeking to conduct clinical research in the NHS in England. Some of this research is funded by the NIHR, but most of it is funded by NHS non-commercial partners and industry.
We support the set up and delivery of clinical research in the NHS through our Study Support Service and our Research Design Service helps researchers develop proposals to secure funding from our research programmes.
The Stroke Specialty is one of 31 specialties which bring together communities of clinical practice to provide national networks of research expertise and clinical leadership. It is made up of research-interested clinicians and practitioners who work at both national and local levels to ensure the studies that are included in our national portfolio of research are delivered successfully in the NHS.
Each of our 15 Local Clinical Research Networks has at least one nominated local Clinical Specialty Research Lead for stroke studies. These clinicians lead research groups to promote and support cardiovascular disease research within the NHS trusts in their area.
At a national level the local leads come together to manage the national stroke research portfolio. This involves regularly reviewing the progress of studies, identifying barriers to recruitment, and coming up with solutions and strategies to help overcome those barriers. Our National Specialty Group of clinical experts offer advice and support to commercial and non-commercial customers looking to conduct research in the NHS.
The UK has a unique research infrastructure set up to deliver stroke studies across the entire stroke pathway. Sites which are able to provide consistent NHS infrastructure, capacity and capability to support a portfolio of stroke studies requiring advanced neuro-imaging, specialist interventional skills and rapid enrolment of patients have been designated Hyperacute Stroke Research Centres (HSRCs).
The accreditation, supported by the NIHR CRN Stroke Specialty, provides sites with an increased support infrastructure to deliver complex interventions within the first nine hours of stroke onset. This includes drugs and device studies.
Our Stroke Specialty profile gives an overview of our offer to the Life Sciences industry.
One third of patients have communication problems after a stroke, this is known as aphasia. People with aphasia are often excluded from participating in research studies due to the difficulties of recruiting patients into studies with this condition. We offer a set of resources to support stroke researchers to help people with aphasia to take part in research.
We have also worked with the Stroke Association to produce the Clinical trials and stroke booklet answering the most common questions about participating in clinical research.
We work with research charities, including the Stroke Association, and patient support organisations to ensure that studies meet patient needs and are successfully delivered in the NHS.
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 neuro-degeneration. 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.
Clinical research is being undertaken across the United Kingdom. We continue to work closely with the Scottish, Welsh and Northern Irish clinical research networks to support the design and delivery of high quality research
The Stroke Association is a national charity providing support, advice and information to people who’ve had strokes, their family, carers and healthcare professionals.
British Heart Foundation is the nation's heart charity and the largest independent funder of cardiovascular research.
BASP is a UK body for stroke physicians specialising in all aspects of stroke to promote the advancement of stroke medicine.
The NIHR provides the support and facilities the NHS needs for first-class research by funding a range of infrastructure.
NIHR Biomedical Research Centres (BRCs), partnerships between England’s leading NHS organisations and universities, conduct translational research to transform scientific breakthroughs into life-saving treatments. The following BRCs undertake research in stroke:
NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) are collaborations between local providers of NHS services and NHS commissioners, universities, other local organisations and the relevant Academic Health Science Network. The primary focus of CLAHRCs is research targeted at chronic disease and public health interventions. The following CLAHRCs undertake research in stroke:
This Partnership between the NIHR and the Bristish Heart Foundation (BHF) is a combined network of world-leading researchers working to translate scientific discoveries into benefits for patients.
All of the NIHR facilities and centres are opening to working with the public, charities, industry and other partners. If you are interested in collaborating with the NIHR please contact the NIHR Office for Clinical Research infrastructure: firstname.lastname@example.org
Our experts in the NIHR Clinical Research Network (National Specialty Leads) can give advice on delivering your stroke study in the NHS.
Prof Tom Robinson undertook his training in Nottingham, Newcastle-Upon-Tyne and Leicester. He is currently Head of the Department of Cardiovascular Sciences and Professor of Stroke Medicine at the University of Leicester, as well as, an Honorary Consultant Physician in Stroke Medicine for University Hospitals of Leicester NHS Trust. He was appointed an NIHR Senior Investigator in April 2016.
His research interests include blood pressure management, cardiovascular autonomic regulation and cerebrovascular autoregulation following acute stroke, and predicting disability in an ageing population; having published over 150 original scientific articles. His research is currently funded by the British Heart Foundation, the Stroke Association, the Engineering and Physical Sciences Research Council, and the National Institute of Health Research.
Prof Robinson has a strong interest in acute stroke clinical trials, being the Chief Investigator of the COSSACS and CHHIPS Trials of acute stroke blood pressure management, and UK Co-ordinating Investigator of the INTERACT2 and ENCHANTED Trials. He serves on a number of Trial Steering, and Data and Safety Monitoring Committees, and is currently the NIHR Clinical Research Network Stroke National Lead.
His other responsibilities include: Chair of the Membership Committee of the European Stroke Organisation, President Elect of the British Association of Stroke Physicians.
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