Motivational interviewing for low mood and adjustment early after stroke: a feasibility randomised trial.

Background: Management of psychological adjustment and low mood after stroke can result in positive health outcomes. We have adapted a talk-based therapy, motivational interviewing (MI), and shown it to be potentially effective for managing low mood and supporting psychological adjustment post-stroke in a single-centre trial. In the current study, we aimed to explore the feasibility of delivering MI using clinical stroke team members, and using an attention control (AC), to inform the protocol for a future definitive trial.

Do studies of the weekend effect really allow for differences in illness severity? An analysis of 14 years of stroke admissions.

Background: An increased mortality rate among patients admitted to hospital at weekends has been found in many studies, and this ‘weekend effect’ has been used to justify major health service reorganisation. Most studies have used routine administrative data to adjust for potential confounding factors, and are unable to measure differences in illness severity due to the tendency of patients with milder symptoms to stay home at weekends. We set out to estimate the importance of such unmeasured ‘confounding by severity’, using data from a hospital stroke register.

Thrombolytic Treatment for Ischaemic Stroke: Could the Crisis of Confidence Have Been Avoided by Better Analysis of Trial Data?

In many countries, thrombolysis with intravenous alteplase has become a central part of acute stroke care in recent years, requiring radical restructuring of services. However, a significant minority of emergency and stroke physicians have always had serious doubts about the safety and efficacy of thrombolytic treatment, and in 2015 these prompted a major review of the licensing status of alteplase by the UK regulatory authorities. Subsequent dramatic headlines and media stories have called into question the integrity of researchers and clinicians and undermined public faith in medical research.

Effects of diagnostic uncertainty and misclassification on hospital performance indicators for acute stroke care.

The Stroke Improvement National Audit Programme (SINAP), now replaced by the Sentinel Stroke National Audit Programme, was established to provide comparative data on hospital performance indicators for stroke, but comparisons are only valid if case ascertainment is complete. In Gateshead we compared initial results from SINAP with those from a pre-existing hospital stroke register, which ran independently for 11 months after SINAP's introduction in 2010, as well as with Hospital Episode Statistics (HES) data. Of 315 confirmed acute stroke cases identified from the three combined data sources, 96 (30%) were omitted from SINAP and 51 (16%) were missed by HES.

Rehabilitation aimed at improving outdoor mobility for people after stroke: a multicentre randomised controlled study (the Getting out of the House Study).

Background: One-third of stroke patients are dependent on others to get outside their homes. This can cause people to become housebound, leading to increased immobility, poor health, isolation and misery. There is some evidence that outdoor mobility rehabilitation can reduce these limitations.

A multi-centre randomised controlled trial of rehabilitation aimed at improving outdoor mobility for people after stroke: study protocol for a randomised controlled trial.

Background: Up to 42% of all stroke patients do not get out of the house as much as they would like. This can impede a person's quality of life. This study is testing the clinical effectiveness and cost effectiveness of a new outdoor mobility rehabilitation intervention by comparing it to usual care.

Mood after stroke: a case control study of biochemical, neuro-imaging and socio-economic risk factors for major depression in stroke survivors.

Background: Though vascular factors may be important in the aetiology of late-life depression, it is not clear whether they have a major effect on the risk of depression after a stroke. We investigated the relationship between physiological, biochemical, neuro-imaging and socio-economic factors and late-phase post-stroke depression in a cross-sectional case-control study.

Methods: People living at home at least 9 months after a stroke were interviewed using a structured proforma.

Very early rehabilitation or intensive telemetry after stroke: a pilot randomised trial.

Background: Stroke patients are more likely to make a good recovery if they receive care in a well-organised stroke unit. However, there are uncertainties about how best to provide such care. We studied 2 key aspects of early stroke unit care: early active mobilisation (EM) and automated monitoring (AM) for physiological complications such as hypoxia.