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Task-specific training versus usual care to improve upper limb function after stroke: the “Task-AT Home” randomised controlled trial protocol
The objective is to determine whether task-specific training is a more effective treatment than usual care, for improving upper limb function, amount of upper limb use, and health related quality of life at 6 weeks and 6 months after intervention commencement. Our primary hypothesis is that upper limb function will achieve a ≥ 5 point improvement on the ARAT in the task-specific training group compared to the usual care group, after 6 weeks of intervention.MethodsParticipants living at home, with remaining upper limb deficit, are recruited at 3 months after stroke from sites in NSW and Victoria, Australia. Fo...
Source: Frontiers in Neurology - June 29, 2023 Category: Neurology Source Type: research

Remote constraint induced therapy of the upper extremity (ReCITE): A feasibility study protocol
DiscussionThe COVID-19 pandemic resulted in a rapid transition to delivering telehealth. The proposed study will investigate the feasibility and acceptability of delivering a complex intervention via telehealth to stroke survivors at home, and the support that therapists and patients require for delivery. The findings of the study will be used to inform whether a larger, randomized controlled trial is feasible.
Source: Frontiers in Neurology - November 18, 2022 Category: Neurology Source Type: research

Spatiotemporal analysis of regional TIA trends
ConclusionOur finding suggests a statically significant spatial component to TIA rate over regional areas but no temporal changes or yearly trends. We propose that such exploratory method should be followed by evaluation of reasons for regional variations and which in turn can identify opportunities in primary prevention of stroke, and stroke care.
Source: Frontiers in Neurology - August 22, 2022 Category: Neurology Source Type: research

Long-Term Cost-Effectiveness of Severity-Based Triaging for Large Vessel Occlusion Stroke
ConclusionsAn ACT-FAST severity-triaging strategy is associated with cost-saving and increased benefits when compared to standard care pathways. Implementing ACT-FAST triaging increased the proportion of patients who received EVT procedure due to more patients arriving at EVT-capable hospitals within the 6-h time window (when imaging selection is less rigorous).
Source: Frontiers in Neurology - May 13, 2022 Category: Neurology Source Type: research

A Systematic Review of Mobile Stroke Unit Among Acute Stroke Patients: Time Metrics, Adverse Events, Functional Result and Cost-Effectiveness
ConclusionA comprehensive analysis of current research suggests that MUS, compared with conventional EMS, has a better performance in terms of time metrics, safety, long-term medical benefits, and cost-effectiveness.
Source: Frontiers in Neurology - March 9, 2022 Category: Neurology Source Type: research

One-Year Risk of Stroke After Transient Ischemic Attack or Minor Stroke in Hunter New England, Australia (INSIST Study)
Conclusion: One-year risk of stroke in TIAMS participants was lower than reported in previous studies. Early implementation of antiplatelet/anticoagulant therapies may have contributed to the low stroke recurrence.
Source: Frontiers in Neurology - December 20, 2021 Category: Neurology Source Type: research

Real-World Cost-Effectiveness of Late Time Window Thrombectomy for Patients With Ischemic Stroke
Conclusions: Treating patients not meeting the DAWN or DEFUSE 3 clinical trial criteria in the extended time window for EVT was associated with less gain in QALYs and higher cost. Caution should be exercised when considering this procedure for patients not satisfying the trial perfusion imaging criteria for EVT.
Source: Frontiers in Neurology - December 14, 2021 Category: Neurology Source Type: research

Telestroke Assessment With Perfusion CT Improves the Diagnostic Accuracy of Stroke vs. Mimic
Conclusions: In the telehealth setting, the absence of an ischaemic lesion on CTP adds to the diagnostic accuracy in distinguishing mimic from stroke, above that from clinical features.
Source: Frontiers in Neurology - December 3, 2021 Category: Neurology Source Type: research

Development and Pilot Implementation of TACTICS VR: A Virtual Reality-Based Stroke Management Workflow Training Application and Training Framework
Delays in acute stroke treatment contribute to severe and negative impacts for patients and significant healthcare costs. Variability in clinical care is a contributor to delayed treatment, particularly in rural, regional and remote (RRR) areas. Targeted approaches to improve stroke workflow processes improve outcomes, but numerous challenges exist particularly in RRR settings. Virtual reality (VR) applications can provide immersive and engaging training and overcome some existing training barriers. We recently initiated the TACTICS trial, which is assessing a “package intervention” to support advanced CT imaging and s...
Source: Frontiers in Neurology - November 11, 2021 Category: Neurology Source Type: research

Application of Machine Learning Techniques to Identify Data Reliability and Factors Affecting Outcome After Stroke Using Electronic Administrative Records
Conclusion: Electronic administrative records from this cohort produced reliable outcome prediction and identified clinically appropriate factors negatively impacting most outcome variables following hospital admission with stroke. This presents a means of future identification of modifiable factors associated with patient discharge destination. This may potentially aid in patient selection for certain interventions and aid in better patient and clinician education regarding expected discharge outcomes.
Source: Frontiers in Neurology - September 27, 2021 Category: Neurology Source Type: research

Regional Differences in Early BP Management After Acute Ischemic Stroke in the ENCHANTED International Randomized Controlled Trials
Conclusion: Regional variations in early BP management in acute stroke translated into differences in early BP control parameters.
Source: Frontiers in Neurology - August 27, 2021 Category: Neurology Source Type: research

Risk Stratification Tool for Ischemic Stroke: A Risk Assessment Model Based on Traditional Risk Factors Combined With White Matter Lesions and Retinal Vascular Caliber
Conclusion: The risk assessment model of ischemic stroke combined with Fazekas grade of WML and CRAE is superior to the traditional risk factor and the single-index model. This model is helpful for risk stratification of high-risk stroke patients.
Source: Frontiers in Neurology - August 4, 2021 Category: Neurology Source Type: research

Network Mapping of Time to Antithrombotic Therapy Among Patients With Ischemic Stroke and Transient Ischemic Attack (TIA)
Conclusion: The proportion of patients receiving antithrombotics within 48 h was higher than previously reported in Australia but remained lower than the standard achieved in North American hospitals. Our process map and network analysis show avenues to shorten the time to antithrombotic.
Source: Frontiers in Neurology - June 7, 2021 Category: Neurology Source Type: research

The Need for Structured Strategies to Improve Stroke Care in a Rural Telestroke Network in Northern New South Wales, Australia: An Observational Study
Conclusion: In our telestroke network, acute stroke timing metrics did not improve over time. There is the need for targeted education and training focusing on both stroke reperfusion competencies and the technical aspects of telestroke in areas with limited workforce and high turnover.
Source: Frontiers in Neurology - April 9, 2021 Category: Neurology Source Type: research

COVID-19 Pandemic Impact on Care for Stroke in Australia: Emerging Evidence From the Australian Stroke Clinical Registry
We present information on acute stroke care for the first wave of the COVID-19 pandemic in Australia using data from the Australian Stroke Clinical Registry (AuSCR). The first case of COVID-19 in Australia was recorded in late January 2020 and national restrictions to control the virus commenced in March. To account for seasonal effects of stroke admissions, patient-level data from the registry from January to June 2020 were compared to the same period in 2019 (historical-control) from 61 public hospitals. We compared periods using descriptive statistics and performed interrupted time series analyses. Perceptions of stroke...
Source: Frontiers in Neurology - February 26, 2021 Category: Neurology Source Type: research

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