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2014 will bring surprises and improvements ...

2014 will bring surprises and improvements

December 2014 Editorial

Once again we have reached the end of a very successful year in the history of the International Journal of Stroke. Now at the end of our eighth year, we are in the fortunate position of having an impact factor on the rise, attributed to the quality of manuscripts, which you are submitting, and the readability of the journal. In this vein the structure continues to evolve.

Many of you will recall that we launched the journal with a content focused solely on review, but have gradually evolved the format to include a modest number of high quality research articles, and an annual bumper research edition. 

This change in structure has also been in response to the extraordinary number of submissions that you have made, emphasizing the appetite and need for more top quality science to be published, and new vehicles for publication. The whole publishing industry is undergoing the most rapid change, perhaps since the invention of the printing press. What the journal landscape will look like even within five years is hard to predict, what we do know is that we must evolve rapidly!

The second structural alteration has been to expand our Editorial Board roles. We have introduced new section editors, who are leaders in their field, I warmly welcome:  Genetics: Martin Dichgans - Germany, Hugh Markus - UK; Basic Science: Malcolm McLeod – UK, David Howells - Australia; Imaging: Mark Parsons – Australia; Acute therapy: Andrew Demchuk – Canada, Peter Sandercock – UK; Rehabilitation:

Marion Walker – UK, Julie Bernhardt – Australia; Cognition disorder: Amy Brodtmann – Australia, and Sarah Pendlebury – UK.

I am certain they will all make a wonderful contribution to the matrix of the journal.

As well as working to engage science leaders in their field, we are also building on the wealth of experience in the field of stroke from our senior colleagues who will contribute as consulting editors; it is a pleasure to welcome: Stephen Davis – Australia; Veronika Skvortsova – Russia; Bo Norrving – Sweden; Ulrich Dirnagl –Germany; Graeme Hankey – Australia; Conrado Estol – Argentina.

We would like to thank Michael Hennerici for agreeing to continue to support us in this role after assisting us to pioneer the journal.

You’ll be pleased to know that the evolutionary process continues, and in 2014 there will be a number of surprises and improvements for our expanding and dedicated readership. See you next year!

Geoffrey A. Donnan

Canadian Best Practice Recommendations for Stroke Care : Stroke Rehabilitation update

New recommendations released by the Heart and Stroke Foundation of Canada stroke guidelines team for physicians, nurses and allied health professionals, reinforce that stroke rehabilitation is not limited to a single location, but is an ongoing process that includes a range of activities in many settings taking place over months or years. This updated set of recommendations emphasizes all components of dedicated stroke rehabilitation services, from rehabilitation units, to outpatient clinics and programs in the community; taking a more holistic approach to stroke rehabilitation as being available ‘anywhere, anytime'.

"Stroke rehabilitation is a progressive, dynamic, goal-oriented process that works to restore neurological deficits occurring as a consequence of a stroke. Rehabilitation should begin immediately after a stroke and involves interdisciplinary teams working together to maximize the individual's recovery. Rehabilitation continues after the patient leaves hospital to ensure the patient achieves maximal recovery and is successfully reintegrated back into the community."

says Dr. Robert Teasell, Professor of Physical Medicine and Rehabilitation, Schulich School of Medicine, Western University in London, and senior writer, Stroke Rehabilitation Writing Group.

The recommendations also highlight the need for an increase in early-supported discharge, which allows patients to return to their previous living setting as early as possible, where appropriate. The significant benefits to this approach include better quality of life for the patient and decreased burden on the health care system. In order for early supported discharge to be successful, it needs to be delivered within an organized system of stroke care to provide the best outcomes for patients.

Recent reports on the quality of stroke rehabilitation and recovery services reveal considerable variation in availability and access within Canada and across many developed countries.  Access is considerably more variable and less available in developing countries that lack the expertise and resources for long-term rehabilitation.  New strategies and the use of technology, such as telestroke, should be considered to bridge this gap.

“The evidence supporting the positive impact that rehabilitation plays in stroke recovery is both strong and growing. However, the key is the availability and accessibility to critical rehabilitation programs and services. On a system level there continues to be many gaps in terms of people being able to access timely and intensive rehabilitation in both inpatient and outpatient settings. Rehabilitation should clearly be an area of focused uptake for stroke care best practices as it will result in significant gains for both patients and the health system”

 says Mark Collison, Director, Advocacy & Stakeholder Relations, Heart and Stroke Foundation, British Columbia and Yukon.

Rehabilitation crosses all settings of care, and a broad range of providers and caregivers, and families and other informal caregivers play a critical role.  The patient, their family and caregivers must be included in goal setting, planning for the types of rehabilitation required and selecting the most appropriate setting to receive the needed rehabilitation.

The Canadian Best Practice Recommendations for Stroke Care is a joint initiative of the Heart and Stroke Foundation and the Canadian Stroke Network.

Patty Lindsay

Director Best Practices and Performance, Stroke

Heart and Stroke Foundation | Fondation des maladies du cœur et de l'AVC

International Journal of Stroke joins Vimeo

https://vimeo.com/internationaljstroke

In our latest video upload we present Professor Geoffrey Donnan, Editor-in-Chief of the International Journal of Stroke in conversation with Professor Ulrich Dirnagl.

Patient involvement in stroke research examples of good practice in the United Kingdom

Patient involvement in stroke research: examples of good practice in the United Kingdom

Dr Madina Kara on behalf of the Stroke Association

Dr Madina Kara

Stroke Association

240 City Road, London, EC1V 2PR, UK

Madina.Kara@stroke.org.uk

Service users are the only people who really understand how a condition affects their day to day life. They have a unique insight that allows them to identify and prioritise areas where research is required, as well as to assist with designing the research. Efforts have been made to involve stroke survivors in stroke research and this has helped move the field forward resulting in fewer strokes, better treatment and rehabilitation, but there is still work to be done.

Public involvement in research is on the increase and many funding bodies require grant applicants to demonstrate how service users will be involved in the research project. However, it is important that researchers do not just pay ‘lip service’ to this requirement and recognise the value that service user involvement can bring to research.

The StrokeAssociation is a stroke support organisation that works with stroke survivors and their families in the United Kingdom to provide information, advice and support, as well as funding vital research into stroke.  We place the stroke survivor at the heart of everything we do and this includes in all our research activities.

Stroke survivors help choose the research we fund

The Stroke Association ensures that people affected by stroke have an opportunity to help choose the research that we fund. Through our Service User Review Panel stroke survivors, carers and their family members can review all the applications that have been found to be scientifically sound through our peer-review process. They then rank the applications according to the importance of the research to them.

These rankings are added to those of the Research Awards Committee, made up of scientists and clinicians as well as service user representatives, and the overall top ranking applications are funded. This way, we make sure that our research addresses the needs of the people who will ultimately benefit from it.

Stroke survivors as research co-designers

Example 1: For an aphasia trial

Approximately one third of stroke survivors experience a communication disorder known as aphasia. We are currently funding the EVA project led by Professor Jane Marshall at City University London which is evaluating the effects of a virtual environment for people with aphasia.

Consultants with aphasia have been recruited to support the design of the virtual communication environment. The EVA consultants with aphasia are paid members of the project team.  They are involved in participative design workshops in which they feedback on all aspects of the technology.  For example, they have advised the research team on what should (and should not) be included in the virtual world (EVA Park), and about navigation options.  Professor Marshall says ‘Their input is helping to ensure that EVA Park will be enjoyable, beneficial and easy to use for people with aphasia’.

Example 2: For a vision trial

Visual problems are common after stroke. Hemianopia, a condition where there is a loss of one half of the visual field in both eyes occurs in about 20 per cent of patients in the longer term. This condition can make stroke survivors more prone to falls, affect reading ability and significantly affect their quality of life. We are currently funding the VISION trial led by Dr Fiona Rowe at the University of Liverpool. This trial aims to compare two types of treatment for hemianopia after stroke-

•      the use of visual scanning which involves training the individual to make more effective eye movements into the area with visual loss, and
•      the use of Prism glasses which are used to move images of objects from the blind side of vision into the seeing side.

This trial has benefited from the inclusion of a stroke survivor with visual impairment on the research team, who helped to prepare the grant application as well as acting as a consultant throughout the trial. They helped to develop the information sheet and consent form to make it accessible and clear and also advised on the best way to disseminate final results for patients and the public. “Involving a stroke survivor as an equal member of the grant team has been invaluable to the research,” explains Dr Rowe. “Her contributions have brought confidence and reassurance to the team that the research question is important, that the treatments offered are appropriate and that the information provided to stroke survivors is in a format acceptable to stroke survivors”

Recruitment of stroke survivors to clinical trials

It is important to take into account the difficulties of involving stroke survivors in research. There are some common problems after stroke including communication difficulties and cognitive problems which can affect a person’s ability to understand and participate in research studies.

We have produced a clinical trials booklet explaining what a clinical trial is and what it involves in order to help patients make informed decisions about taking part in research. To promote the inclusion of stroke survivors with aphasia, we have also produced an aphasia-friendly version so that people who have trouble understanding written information can also understand the process and get involved. But a lot more work needs to be done to ensure that all researchers make an effort to include all stroke survivors, e.g. by ensuring that the patient information provided for their trial is accessible to those with communication difficulties.

People affected by a condition have the right to have a say in what research is undertaken. It is also very important to inform patients on the outcome of research projects. Many studies do this through a dedicated trial website, or newsletters.

Over the past 20 years the Stroke Association has supported vital stroke research and we continue to inform the public of the achievements of the research we have funded so that they are aware of the difference their donations make.