Number Of Stroke Survivors Research Articles

Investigating the Predictive Value of Thyroid Hormone Levels for Stroke Prognosis.

Given the expansion of life expectancy, the aging of the population, and the anticipated rise in the number of stroke survivors in Europe with severe neurological consequences in the coming decades, stroke is becoming the most prevalent cause of functional disability. Therefore, the prognosis for a stroke must be timely and precise. Two databases (MEDLINE and Scopus) were searched to identify all relevant studies published between 1 January 2005 and 31 December 2022 that investigated the relationship between thyroid hormone levels and acute stroke severity, mortality, and post-hospital prognosis. Only full-text English-language articles were included. This review includes Thirty articles that were traced and incorporated into the present review. Emerging data regarding the potential predictive value of thyroid hormone levels suggests there may be a correlation between low T3 syndrome, subclinical hypothyroidism, and poor stroke outcome, especially in certain age groups. These findings may prove useful for rehabilitation and therapy planning in clinical practice. Serum thyroid hormone concentration measurement is a non-invasive, relatively harmless, and secure screening test that may be useful for this purpose.

BALANCE, GAIT AND LATEROPULSION DISORDERS IN THE ACUTE ISCHEMIC STROKE

Introduction: Stroke mortality rates has decreased to a considerable value over the past few decades owing to the improved medical facilities and technology. This has lead to more number of stroke survivors in the aging population. A strong predictor of independent living after stroke is maintaining body balance and it was showing strong correlation with the disability perceived at the time of patient's discharge from the stroke rehabilitation unit Methodology: All patients with acute ischemic stroke were taken for study. These initial assessments collected information about handedness, all motor decits, postural instability and gait disorders, and disability affecting motor function. The second assessment was performed after one week of stroke at the discharge after daily physiotherapy and only focused on postural and gait disorders. Motor weakness was assessed by a standardized examination of muscle strength adapted for participants with central neurological disorders. Lateropulsion, gait and balance disorders were identied by specic protocols. Results: It was observed that the lesions of frontal lobe, thalamus, basal ganglia and internal capsule had signicant assosciation with balance and gait abnormality post stroke while lesions of parietal lobe, temporal lobe and occipital lobe did not lead to any signicant gait or balance decits. Individuals with lateropulsion improves well on daily physiotherapy in both Lw/oP (r = -0.65) and for pushers (r = -0.61) to a signicantly improved state( r= -0.5 for upright and r= -0.24 for pushers).Conclusion: Lateropulsion is a main factor in determining recovery of balance and gait in the subacute stage of stroke recovery. Special emphasis should be given to the impaired body orientation with respect to gravity in stroke rehabilitation stage and techniques to improve lateropulsion has to be stressed during physiotherapy for better recovery of balance and gait post stroke

Stroke Rehabilitation Fact Sheet in Korea.

With rapid aging, the number of stroke survivors with disabilities in Korea is increasing even if mortality is declining. Despite coordinated efforts for quality improvement of stroke rehabilitation in Korea, the statistics of stroke rehabilitation were not well reported. This review aimed to provide contemporary and comprehensive statistics and recent changes in stroke rehabilitation in Korea. The Clinical Practice Guideline for Stroke Rehabilitation in Korea was developed in 2009 and updated in 2012 and 2016. Additionally, the representative databases for stroke rehabilitation include the Korean Brain Rehabilitation Database and the Korean Stroke Cohort for functioning and rehabilitation. These nationwide databases provided current information on stroke rehabilitation. Among Korean stroke survivors, one in three had motor impairment, one in four had cognitive impairment, one in three had speech impairment, one in four was dependent in ambulation, one in six had swallowing difficulty, and one in four was dependent in activities in daily living at 5 years after stroke. Comprehensive inpatient rehabilitation following transfer to the department of rehabilitation medicine significantly decreased stroke-related mortality and long-term disability. This review provides an improved understanding of stroke rehabilitation and guidance to implement timely, coordinated, evidence-based stroke rehabilitation services to relieve the socioeconomic burden of stroke.

A Review of International Experience for Telerehabilitation of Post-stroke Patients with Aphasia and Cognitive Problems

Stroke remains one of the most common reasons of disabilities worldwide. Aphasia, memory and cognitive problems are among common stroke consequences significantly reducing stroke survivors’ life quality. To grant access of a large number of stroke survivors to rehabilitation services, and sustain continuous rehabilitation during pandemic, the telerehabilitation can be used. This article summarizes current approaches on telerehabilitation of post-stroke patients with aphasia, cognitive and memory problems. Authors made a search of research articles and review papers from international medical journals indexed in Scopus, Sciencedirect, and PubMed databases. The results show that the telerehabilitation is feasible providing significant clinical outcomes and can be organized synchronously and asynchronously to meet needs for increasing demand of post-stroke patients. Despite the positive effects of telerehabilitation, there were some limitations. To overcome these limitations, further clinical studies on large groups are needed.

Telerehabilitation—A Viable Option for the Recovery of Post-Stroke Patients

As the number of stroke survivors is continuously growing, with an important number suffering from consequent functional deficits, the rehabilitation field is facing more complex demands. Technological progress gives us the opportunity to remotely assist patients while they exercise at home through telerehabilitation (TR), addressing the problems of limited medical resources and staff, difficult transportation, or living a long distance from rehabilitation centers. In addition, TR is a way to provide continuity in long-term post-stroke recovery during the COVID-19 pandemic, which limits traveling and human interaction. While the implementation of TR is increasing, the biggest challenges are to raise patients’ acceptability of the new method and their motivation and engagement during the program. In this review, we aimed to find methods to address these challenges by identifying the patients who benefit the most from this therapy and efficiently organizing the space and technology used for telerehabilitation. User-friendly technologies and devices along with therapists’ constant support and feedback are some of the most important aspects that make TR an efficient intervention and an alternative to conventional therapy.

Accessibility and effectiveness of mechanical thrombectomy for ischaemic stroke in Latin American countries: a rapid review of the literature

Introduction. Stroke constitutes a major cause of death and disability in Latin America. Although the number of stroke survivors has increased in recent decades, a small proportion receives the appropriate treatment. Mechanical thrombectomy (MT) revolutionised stroke management by treating patients within a 24-hour window period, compared to the usual 4.5 hours with intravenous recombinant tissue plasminogen activator (IV rtPA). Objective. To evaluate the current status of mechanical thrombectomy in Latin American countries regarding availability, accessibility, effectiveness, and cost-utility. Methods. A rapid review of the literature was performed by identifying papers published in MEDLINE in English or Spanish from 2015 to current. Reference list search complemented the database research. Included studies were randomised controlled trials and observational studies. Data extraction was performed by one reviewer, and data synthesis was performed following the SWIM guidelines. Results. 10 studies were included. Only one study was a randomised controlled trial. Studies reported that MT is available in Latin American countries. The proportion of treated patients varied from 3% to 19.9%. Recanalisation rates were above 69% in all studies, while functional independence (mRS 0-2) varied from 25% to 50%. Financial barriers were considered as the main limiting factor to access MT. No study realised a cost-utility analysis. Conclusion. Evidence of the efficacy and effectiveness of MT and its main barriers to access is consistent among Latin American countries. Further research is needed, mainly from a robust economic analysis, to evaluate the economic impact of MT.

Longer-term health and social care strategies for stroke survivors and their carers: the LoTS2Care research programme including cluster feasibility RCT

Background It is reported that the longer-term outcomes for stroke survivors are poor, with a range of unmet needs identified. Objectives The aims were to develop and test a longer-term stroke care strategy focused on improving the quality of life of stroke survivors and their carers by addressing unmet needs, and maintenance and enhancement of participation (i.e. involvement in life situations). Design Five overlapping workstreams were undertaken – (1) refinement of content by semistructured interviews with stroke survivors and their carers and by a review of the literature to inform content and delivery of the care strategy; (2) exploration of service models by national survey and focus groups with purposely selected services; (3) intervention development by interaction with a reference group of stroke survivors, carers, and health and social care professionals; (4) refinement and pilot implementation of the developed intervention in three stroke services (case studies); and (5) a cluster randomised controlled feasibility trial in 10 stroke services across England and Wales. Setting The intervention development work and feasibility trial were in stroke services (inclusive of primary, secondary, community and social care provision) across England and Wales. Participants Participants were stroke survivors resident in the community and their carers, and health and social care professionals in the included stroke services. Data sources Interviews with 28 stroke survivors and their carers at least 9 months post stroke ascertained their needs and the barriers to and facilitators of addressing those needs. Additional literature reviews identified 23 needs. No evidence-based interventions to address these needs were reported; self-management was highlighted as a possible delivery mechanism. In workstream 2, a national survey revealed that the most common model of stroke service provision was care up to 12 months post stroke, reported by 46 (40%) services. Thirty-five (30%) services provided care up to 6 months post stroke and 35 (30%) provided care beyond 12 months, thus identifying 6 months post stroke as an appropriate delivery point for a new intervention. Through focus groups in a range of services, stroke survivors’ perceived unmet needs and the barriers to and enablers of service provision were identified. Intervention Using information obtained in workstreams 1 and 2 and working closely with a stakeholder reference group, we developed an intervention based on the unmet needs prioritised by stroke survivors and their carers (workstream 3). In workstream 4, action groups (clinicians, stroke survivors and researchers) were established in three stroke services that led implementation in their service and contributed to the iterative refinement of the intervention, associated training programme and implementation materials. The intervention (called New Start) was delivered at 6 months post stroke. Key components were problem-solving self-management with survivors and carers, help with obtaining usable information, and helping survivors and their carers build sustainable, flexible support networks. Results A cluster randomised feasibility trial (workstream 5) was successfully implemented in 10 stroke services across England and Wales, with associated process and health economic evaluations. Five services were randomised to provide New Start, while five continued with usual care; 269 participants were recruited. Progression criteria – in terms of our pre-determined (red, amber, green) criteria for progress to a full trial: target stroke survivor recruitment rates were achieved, on average, across sites (24.1 per site over 6 months, green); 216 (80.3%) registered stroke survivors returned follow-up questionnaires at 9 months (84.1% in the intervention arm and 75.8% in the usual care arm, green); according to data reported by sites, overall, 95.2% of registered stroke survivors were offered at least one session of the intervention (green); all five intervention sites had at least two facilitators deemed competent, delivered the New Start intervention and provided it to stroke survivors (green). However, at some sites, there were concerns regarding the number of stroke survivors being offered, accepting and receiving the intervention. Only small differences in outcomes and costs were observed between the New Start and usual care groups, and considerable uncertainty around the cost-effectiveness remains. Conclusions We report a complex programme of work that has described the longer-term needs of stroke survivors and highlighted evidence and service gaps. Working closely with stroke survivors, an intervention was developed that has been refined in three services and feasibility tested in a cluster randomised controlled trial. Further refinement of the target population and optimisation of the intervention materials is required prior to a full randomised controlled trial evaluation. Future work Optimisation of the intervention, and clearer specification of recipients, are required prior to a full trial evaluation. Trial registration Current Controlled Trials ISRCTN38920246. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 3. See the NIHR Journals Library website for further project information.

Reliability and Validity of the Korean Version of Stroke-Specific Quality of Life Questionnaire.

BACKGROUND: The number of stroke survivors is increasing worldwide, and because stroke survivors are usually living with sequelae, health-related quality of life is growing in importance. The stroke-specific quality of life (SSQOL) questionnaire was developed to assess the quality of life in stroke patients. This study aims to test the validity and reliability of the Korean version of the SSQOL (SSQOL-K). METHODS: This study used a descriptive survey design. The participants consisted of 250 stroke patients visiting Dong-A University Hospital in South Korea, who completed the SSQOL-K, the Korean version of the Modified Barthel Index, the Korean version of the Center for Epidemiological Studies Depression Scale, and the Korean version of the World Health Organization Quality of Life Scale Abbreviated Version. For data analysis, exploratory factor analyses with parallel analysis and reliability testing were performed using SPSS version 23.0. RESULTS: The mean total score for the SSQOL-K was 177.75 ± 40.83 (range, 49-245). In the exploratory factor analysis results, 4 subdomains were identified in the SSQOL-K and all items had a factor loading of greater than 0.30. The SSQOL-K was significantly correlated with the Korean version of the Modified Barthel Index, the Korean version of the Center for Epidemiological Studies Depression Scale, and the Korean version of the World Health Organization Quality of Life Scale Abbreviated Version. In reliability testing, the SSQOL-K showed Cronbach α of 0.98 in this study, and Cronbach α for the 4 subdomains were all 0.70 or greater. CONCLUSIONS: The SSQOL-K is a valid and reliable scale to assess health-related quality of life in Korean stroke patients.

The future incidence, prevalence and costs of stroke in the UK.

Backgroundwe project incidence and prevalence of stroke in the UK and associated costs to society to 2035. We include future costs of health care, social care, unpaid care and lost productivity, drawing on recent estimates that there are almost 1 million people living with stroke and the current cost of their care is £26 billion.Methodswe developed a model to produce projections, building on earlier work to estimate the costs of stroke care by age, gender and other characteristics. Our cell-based simulation model uses the 2014-based Office for National Statistics population projections; future trends in incidence and prevalence rates of stroke derived from an expert consultation exercise; and data from the Office for Budget Responsibility on expected future changes in productivity and average earnings.Resultsbetween 2015 and 2035, the number of strokes in the UK per year is projected to increase by 60% and the number of stroke survivors is projected to more than double. Under current patterns of care, the societal cost is projected to almost treble in constant prices over the period. The greatest increase is projected to be in social care costs—both public and private—which we anticipate will rise by as much as 250% between 2015 and 2035.Conclusionthe costs of stroke care in the UK are expected to rise rapidly over the next two decades unless measures to prevent strokes and to reduce the disabling effects of strokes can be successfully developed and implemented.

Neighborhood Socioeconomic Status and Trajectories of Physical Health-Related Quality of Life Among Stroke Survivors.

Background and Purpose- Stroke is the leading cause of serious, long-term disability in the United States, and the number of stroke survivors is projected to rise. Physical functioning status may be compromised in survivors living in low socioeconomic status environments in comparison to higher socioeconomic status environments. Higher socioeconomic status environments may include benefits in the built environment such as sidewalks, accessible transit, or low traffic volume. Investigation is needed to understand the effects of the socioenvironmental context on trajectories of stroke survivors' physical health-related quality of life (PH-QOL) over time. Methods- Participants from the REGARDS (REasons for Geographic and Racial Differences in Stroke) study enrolled in the ancillary Caring for Adults Recovering from the Effects of Stroke project completed the SF-12 around 6 to 12, 18, 27, and 36 months poststroke. Measures of area-level income, wealth, education, and employment at the census tract level were combined to represent participants' neighborhood socioeconomic status. Linear mixed models were used to predict trajectories of PH-QOL over time, controlling for individual characteristics. Results- The average trajectory of PH-QOL was flat over time. However, women and younger stroke survivors had better trajectories over time than men and older stroke survivors. Higher neighborhood socioeconomic status was significantly associated with better PH-QOL across all time points (β=1.73; 95% CI, 0.17-3.30), after controlling for demographic variables and severity of stroke. Conclusions- Our findings demonstrate that neighborhood socioeconomic status, sex, and age are associated with the poststroke recovery process. The results of this study suggest the importance of evaluating the environment surrounding stroke survivors when they return to their home communities. Future research should identify specific features of the environment within different socioeconomic status neighborhoods to better understand how they contribute to PH-QOL among stroke survivors.

Genetic underpinnings of recovery after stroke: an opportunity for gene discovery, risk stratification, and precision medicine

As the number of stroke survivors continues to increase, identification of therapeutic targets for stroke recovery has become a priority in stroke genomics research. The introduction of high-throughput genotyping technologies and novel analytical tools has significantly advanced our understanding of the genetic underpinnings of stroke recovery.

Efficacy and Usability of eHealth Technologies in Stroke Survivors for Prevention of a New Stroke and Improvement of Self-Management: Phase III Randomized Control Trial.

Background: Stroke is a leading cause of severe and long-term disability in developed countries. Around 15 million people suffer a stroke each year, being most of them ischemic due to modifiable risk factors. Adequate self-management abilities may help to manage the consequences of stroke, but it is unknown which specific intervention could be effective to booster these self-management abilities. Objective: To evaluate the improvement of self-management in chronic stroke survivors using decision support and self-management system (STARR). Methods: A randomized, prospective, parallel group, open, and the unicentric pilot trial will be performed. Stroke survivors and their caregivers will be randomly allocated to STARR management or standard of care. Main inclusion criteria are mild to moderate disabled first stroke adult survivor, living at home, able to cope and follow the guidelines and devices, without socio-familial exclusion. All will get a conventional treatment in the acute and subacute phase; however, in the chronic period, cases will use the developed STARR App and Decision Support System. Measurements will be performed at baseline, at 3 months, and at 6 months. Outcome measures are patient-report outcome measure of self-management competency, physical function, risk factor reduction, healthcare resource utilization, knowledge of the condition, mood, and social isolation. Discussion: If effective, the results of this study will enable stroke patients and their caregivers to deal better with the everyday life obstacles of stroke, improve the adherence of the treatment, improve the control of cardiovascular risk, and, in consequence, reduce the recurrence of secondary strokes, the number of complications, the number of consultations, and readmissions; to ultimately reduce the health systems costs. Taking into consideration that the number of stroke survivors is increasing around the world, a large number of individuals could profit from this intervention.

Home self-training: Visual feedback for assisting physical activity for stroke survivors

Background and Objective: With the increase in the number of stroke survivors, there is an urgent need for designing appropriate home-based rehabilitation tools to reduce health-care costs. The objective is to empower the rehabilitation of post-stroke patients at the comfort of their homes by supporting them while exercising without the physical presence of the therapist.Methods: A novel low-cost home-based training system is introduced. This system is designed as a composition of two linked applications: one for the therapist and another one for the patient. The therapist prescribes personalized exercises remotely, monitors the home-based training and re-adapts the exercises if required. On the other side, the patient loads the prescribed exercises, trains the prescribed exercise while being guided by color-based visual feedback and gets updates about the exercise performance. To achieve that, our system provides three main functionalities, namely: 1) Feedback proposals guiding a personalized exercise session, 2) Posture monitoring optimizing the effectiveness of the session, 3) Assessment of the quality of the motion.Results: The proposed system is evaluated on 10 healthy participants without any previous contact with the system. To analyze the impact of the feedback proposals, we carried out two different experimental sessions: without and with feedback proposals. The obtained results give preliminary assessments about the interest of using such feedback.Conclusions: Obtained results on 10 healthy participants are promising. This encourages to test the system in a realistic clinical context for the rehabilitation of stroke survivors.

Nationwide Impact of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines on Stroke Survivors.

BackgroundIn this study, we aimed at estimating the prevalence and number of stroke survivors with hypertension, recommended pharmacological treatment, and above blood pressure target, according to the 2017 American College of Cardiology/American Heart Association guidelines and the seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure guidelines.Methods and ResultsWe included participants aged ≥20 years to the National Health and Nutrition Examination Surveys between 2003 and 2014. The National Health and Nutrition Examination Surveys is a series of publicly available, cross‐sectional, national, stratified, multistage probability surveys. The National Health and Nutrition Examination Surveys received approval from the National Center for Health Statistics Research Ethics Review Board. Stroke was determined by self‐report. Blood pressure was estimated according to National Health and Nutrition Examination Survey protocol. Assessment of pharmacological treatment of hypertension was by self‐report. The proportion and number of stroke survivors with hypertension was 49.8% (95% confidence interval [CI], 45.4%–54.2%) and 2 361 075 (95% CI, 2 035 251–2 686 899) per the 2017 American College of Cardiology/American Heart Association guidelines versus 29.9% (95% CI, 26.2%–33.7%) and 1 415 974 (95% CI, 1 191 721–1 640 227) per seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines. Proportion and number of stroke survivors who were not at target blood pressure was 56% (95% CI, 51.2%–60.6%) and 1 824 106 (95% CI, 1 558 846–2 089 366) per 2017 American College of Cardiology/American Heart Association guidelines versus 36.3% (95% CI, 31.6%–41.4%) and 1 184 655 (95% CI, 984 128–1 385 182) per seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines.ConclusionsCompared with seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the 2017 American College of Cardiology/American Heart Association hypertension guidelines would result in a nearly 67% relative increase in the proportion of US stroke survivors diagnosed with hypertension and 54% relative increase in those not within the recommended blood pressure target.

Increasing Burden of Stroke: The Dijon Stroke Registry (1987–2012)

Background: We aimed to provide a representation of the global burden of stroke. Methods: All cases of stroke were prospectively identified through the population-based registry of Dijon, France (1987–2012). Attack rates and mortality rates (defined as stroke leading to death within 30 days) were standardized to the European standard. Sex differences and temporal trends were evaluated by calculating rate ratios (RRs). Results: In all, 5,285 stroke cases (52.7% women) were recorded. The standardized attack rate was 98.2/100,000/year and the mortality rate was 12/100,000/year, and both were lower in women than in men (RR 0.67, p < 0.001, and RR 0.70, p < 0.001, respectively). Attack rates increased over time (RR 1.016; 95% CI 1.013–1.020) irrespective of the stroke subtype. In contrast, mortality rates declined (RR 0.985; 95% CI 0.976–0.995) with decreasing rates for ischemic stroke but no change for intracerebral hemorrhage and subarachnoid hemorrhage. The sex gap in both attack and mortality rates remained stable. Between the first (1987–1991) and the last (2007–2012) study periods, the annual number of stroke patients who survived beyond 30 days rose by 55%, Conclusions: Increasing attack rates and decreasing mortality have led to a rise in the number of stroke survivors in the population, thus indicating a growing need for the implementation of dedicated services.

Abstract 134: Cost-Related Nonadherence to Medication Among US Stroke Survivors After Affordable Care Act Implementation

Background and Objectives: Medication nonadherence is associated with increased risk of cardiovascular disease (CVD) events among patients with CVD. In 2014, many Americans gained the option of purchasing health insurance coverage and states gained the option of expanding Medicaid eligibility under the Affordable Care Act (ACA). Little is known regarding cost-related nonadherence (CRN) to medication among US stroke survivors after implementation of the ACA. We assessed CRN to medication by age, insurance, and time in a national sample of stroke survivors. Methods: Among 5,011 stroke survivors 45 or older responding to the National Health Interview Survey years 2011 to 2015, we examined CRN to medication within the last 12 months by age and insurance because Medicare eligibility begins at 65. We used logistic regression to adjust for socio-demographic and clinical factors. We compared results from 2014 to 2015 to those from 2011 to 2013 as well as to our previous investigation of age-related differences in CRN to medication from 2006 to 2010. Results: In 2015, 13% of US stroke survivors reported CRN to medication. From 2010 to 2015, the percentage of stroke survivors who were uninsured decreased from 7% to 3% overall (57% decrease) (P&lt;0.001) and from 15% to 7% among survivors aged 45-64 (53% decrease) (P&lt;0.001). From 2011-2013 to 2014-2015, the percentage of stroke survivors aged 45-64 with Medicaid coverage increased from 24% to 31% (P&lt;0.01). From 2006 to 2015, CRN to medication remained stable among younger stroke survivors (Ptrend=0.19) and increased slightly among older stroke survivors (Ptrend=0.01)(Figure). Conclusions: Among stroke survivors who are aged 45-64 years, insurance coverage, namely Medicaid, has increased substantially while CRN to medication has remained stable. Federal programs to improve insurance availability and access to care may not be reducing CRN as intended, and a resulting large number of stroke survivors are at risk for subsequent events.

Mobile tablet-based therapies following stroke: a systematic scoping review protocol of attempted interventions and the challenges encountered

BackgroundStroke is a growing global epidemic limiting the ability of millions to function independently due to post-stroke deficits and complications. Although specialized stroke rehabilitation improves the recovery of functional abilities, accessing rehabilitation services has become increasingly challenging as the number of stroke survivors continues to increase and rehabilitation resources remain scarce. Mobile tablet-based therapies (MTBTs) may be a resource-efficient platform for providing stroke rehabilitation services. The feasibility and challenges of offering MTBTs to stroke survivors should be well understood before expensive, large-scale clinical trials are undertaken to study treatment efficacy.MethodA systematic scoping review will be conducted to describe attempted MTBTs following stroke and the challenges encountered by survivors and study staff. Studies of interest will evaluate MTBTs offered to adult stroke patients in response to post-stroke complications or deficits. Journal databases, gray literature sources, clinical trial registries, relevant organizational websites, and reference lists of eligible studies will be searched to identify suitable studies. Study characteristics, barriers to care, methodological challenges, patient-reported outcomes, and health outcomes will be extracted to describe MTBTs and understand the challenges encountered in context. Results will be presented using descriptive statistics, tables, figures, and narrative description to summarize the scope of the field.DiscussionTrends in MTBT feasibility and common challenges will be discussed to summarize major findings and highlight research gaps. Solutions to common challenges experienced by intervention participants and study staff will be proposed. Implications for the conduct of randomized clinical trials of MTBT efficacy and the appropriateness of a systematic review and meta-analysis of completed trials will be discussed.Systematic review registrationuO Research (http://hdl.handle.net/10393/35696).

Abstract WP381: The Culture Influence on Coping and Adaptation to Stroke Caregiving: the Chinese Family Caregivers’ Experience

Introduction: In China, the estimated number of stroke survivors is 22.5 million, of which 78% need home care. It has been indicated that culture could play a major role on the stroke caregiving experiences. Understanding stroke caregivers’ coping and adaptation within Chinese culture is needed. Objective: To explore how Chinese culture influences the coping and adaptation to stroke caregiving among stroke caregivers. Methods: In this qualitative descriptive study, 25 stroke caregivers (age 52±15.6, 60% female, 58% children-caregivers, 40% spouse-caregivers) were recruited from an 1800-bed regional hospital in China. Data were collected through individual, semi-structured interviews. Qualitative content analysis was performed. Member checking, triangulation of the data and peer debriefing were used to achieve trustworthiness. Results: Three themes emerged from the interviews reflecting the influence of Chinese culture on stroke caregiving: (1) Caregiving role adaptation. Confucianism, which emphasizes duties and responsibilities profoundly influences Chinese world views. Chinese caregivers accepted caregiving for the sick family member as an expected part of life and caregiving is a culturally prescribed obligation. (2) Emotional coping strategies. The emotional coping strategies adopted by caregivers including relying on religion and discussing their feeling with families. Fatalistic appraisal has been described as an emotional coping strategy and Chinese caregivers reported cognitive appraisal of belief system involving ‘ Ming ’ (fate) to help them adapt the caregiving reality. (3) Passive help seeking attitude and behaviors. Chinese caregivers identified self-tolerance and traditional belief of ‘ Ren ’(tolerance)as a negative coping. Chinese caregivers did not actively seek professional/ community help and reluctant to turn to their families and friends for support even though they felt very helpless and isolated. Conclusions: An underlying coping and adaptation of undertaking stroke caregiving within Chinese culture is highlighted in our findings. Researchers and health care professionals who plan to develop a support intervention for Chinese stroke caregivers need to put culture in context.

New hope for ameliorating stroke-induced deficits?

This scientific commentary refers to ‘Electrical stimulation of the motor cortex enhances treatment outcome in post-stroke aphasia’ by Meinzer et al . (doi:10.1093/brain/aww002). The overall decline in stroke mortality observed over the past decades is due to both a reduction in stroke incidence, primarily resulting from cardiovascular risk factor interventions, and substantial progress in the acute treatment of stroke (e.g. recanalization due to thrombolysis and thrombectomy, decompressive therapy) as well as patient care (stroke units) (Mozaffarian et al. , 2016). These improvements (in particular among people older than 65 years) are mirrored, however, by an increasing number of stroke survivors, who are left with persistent neurological deficits. Despite intensive rehabilitation, at least in countries with well developed healthcare systems, many stroke survivors are left with motor, language, spatial or other neuropsychological sequelae, all of which result in reduced functional independence. Consequently, stroke is the leading cause of acquired long-term disability and globally produces immense health, social and economic burdens (Mozaffarian et al. , 2016). While physiotherapy, language therapy and occupational therapy are widely accepted elements of rehabilitation medicine that aim to restore functioning and quality of life in those with physical disabilities or cognitive impairments, novel approaches to rehabilitation are urgently needed. Such therapies may comprise behavioural, pharmacological or technical approaches, the latter including the use of robotic devices as well as non-invasive neuromodulatory techniques [i.e. transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS)]. In this issue of Brain , Meinzer and colleagues raise new hope for the treatment of post-stroke aphasia by showing that electrical stimulation of the motor cortex [sic!] enhances treatment outcomes (Meinzer et al. , 2016). Meinzer and colleagues performed a registered, randomized, sham-controlled, parallel-group, double-blind clinical trial of 26 chronic aphasic patients with anomia [>12 months after stroke …

Epidemiology of stroke and transient ischemic attacks: Current knowledge and perspectives

Because of the growing size and aging of the world's population, the global burden of stroke is increasing dramatically. Current epidemiological data indicate that 16.9million people suffer a stroke each year, which represents a global incidence of 258/100,000/year, with marked differences between high- and low-income countries, and an age-adjusted incidence 1.5 times higher in men than in women. Although primary prevention has contributed to a decrease in stroke incidence in high-income countries, the so-called ‘epidemiological transition’ has led to an increase in incidence in middle-to-low-income countries as well. In addition, the incidence of ischemic stroke in young adults is on the rise, suggesting a need for specific preventative interventions in that age group. The number of stroke survivors almost doubled between 1990 and 2010, and has now reached 33 million people. According to epidemiological projections, this number will rise to 77 million by 2030. In France, the number of hospitalizations for an acute cerebrovascular event was about 138,000 in 2009, accounting for 3% of the total national health expenditure. Outcomes after stroke are frequently impaired by complications, including motor handicaps, dementia, depression, fatigue, and a high risk of early rehospitalization and institutionalization, with adverse consequences in terms of socioeconomic costs. In addition, there are 5.9 million stroke-related deaths worldwide every year. Finally, although many analytical epidemiological studies have considerably increased our knowledge of risk factors for stroke, the recent INTERSTROKE study provided evidence that 10 risk factors alone accounted for 88% of all strokes. Many of these risk factors are modifiable, which suggests that efforts should be made to promote interventions that aim to reduce the risk of stroke. A new ‘mass approach’ aiming to reduce the level of stroke risk factors in all people in a region, regardless of any given individual's level of risk, is currently still being developed. This interesting and innovative way to spread stroke awareness is based on the use of an internationally validated mobile-phone application that can calculate the risk of stroke for any given individual, and also contains a section to educate people on stroke warning symptoms and signs.