Projects

NIHR Health Services & Delivery Research

Many survivors of stroke are left with disabilities and for some these can be very debilitating. Whilst much consideration has been given to the needs of less impaired survivors, there has been a lack of research in terms of how to treat those with more complex needs. 

We have discussed the provision of care for stroke survivors in their own home with our Nottingham stroke partnership group. The group’s comments have informed our study proposal and we will work in partnership with them as the study progresses. The proposal is also based on patient participation in a previous study in which what matters most to stroke survivors with complex needs and their families was investigated. 

Project Lead: Dr Rebecca Fisher

Read more about the HoRRSe study

NIHR Health Services & Delivery Research

We will assess how each ICSS model is staffed in terms of speciality, grade and working hours and associated costs. We will then investigate how much rehabilitation was offered by each service and determine how best this should be reported. We will also investigate how to measure patient recovery and whether these ‘outcome’ measurements relate to how much rehabilitation was provided. Finally, we want to understand the impact of the Covid-19 pandemic in terms of rehabilitation delivery and outcomes.

Project Lead: Dr Rebecca Fisher

Read more about the ICSS study

NIHR Health Services & Delivery Research

The three-year study will investigate the implementation and effectiveness of stroke Early Supported Discharge services across England. It involves a collaboration with the Royal College of Physicians’ Sentinel Stroke National Audit Programme and a world class team of co-applicants from Nottingham, Leicester and Glasgow. The aim is to facilitate provision of evidence based care for stroke survivors leaving hospital.

Project Lead: Dr Rebecca Fisher

Co-Investigators: Professor Marion Walker, Professor Sarah Lewis, Professor Justin Waring, Dr Claudia Geue, Professor Peter Langhorne, Professor Tom Robinson, Alex Hoffman, Prof Tony Rudd

Visit the WISE webpage.

This is a pilot randomised controlled trial to assess the feasibility of a study to investigate the clinical and cost-effectiveness of behavioural activation (BA) therapy for people with post-stroke depression. 

Project Lead: Dr Shirley Thomas

The trial is being coordinated from the Sheffield Clinical Trials Research Unit.

Visit the BEADS webpage

The RETAKE study is a four-year study that aims to determine whether early stroke specific vocational rehabilitation (ESSVR) in addition to usual NHS rehabilitation (UC) is more effective and cost effective at returning stroke survivors to work and keeping them there at 12 months post-randomisation than UC alone.

Chief investigator: Dr Kate Radford

Visit the RETAKE website

The OPTIMISM study aims to develop and evaluate a group psychoeducational intervention for people after a Transient Ischaemic Attack (TIA) and minor stroke. A psychoeducational intervention is a programme providing education and support that can help individuals to cope and adjust with physical, psychological and social difficulties. This project involves two distinct phases (Phase 1: Qualitative Study and Phase 2: Feasibility Trial). It is a single-centre project taking place at the Nottingham University Hospitals and funded by a Stroke Association Postdoctoral Fellowship. 

Project Lead: Dr Eirini Kontou

Co-investigators: Professor Marion Walker, Dr Shirley Thomas, Professor Nikola Sprigg, Professor Dame Caroline Watkins

Visit the OPTIMISM webpage.

The aim of this study was to design, develop and psychometrically evaluate a stroke-specific measure of confidence.  The CaSM questionnaire was developed using the COSMIN framework to ensure globally recognised measurement terms and procedures were applied.    Completed questionnaires were posted to two groups; people who experienced a stroke and older people living in the community.  A 27 item three factor solution was derived assessing Self-Confidence; Positive Attitude; and Social Confidence. The 27 item CaSM is a valid and reliable measure for assessing confidence after having a stroke.

Project Lead: Dr Jane Horne, Research Fellow and Occupational Therapist

Visit the CaSM webpage

CLAHRC funded project

A multi-disciplinary team development programme will be co-designed by clinicians and patients from Northampton Stroke Unit, and researchers from the University of Nottingham during a series of workshops facilitated by Bridges Self-Management Social Enterprise.  The purpose of the programme will be to enhance interdisciplinary working, staff well-being and the implementation of evidence-based stroke rehabilitation in the acute setting. The project is a collaboration between leading experts in the field from Nottingham, London, Leeds and Northampton and will take place between January-September 2019

Project Lead: Dr Rebecca Fisher

Co-investigators: Dr Melanie Blake, Dr Trudi Cameron, Dr Niki Chouliara, Professor David Clarke, Professor Anne Forster, Dr Fiona Jones, Richard Lee, Tim Meads, Vicki Moore, Heide Pöstges, Jenny Scott, Professor Marion Walker.

The ESCAPS study will evaluate the feasibility of running a definitive trial to ascertain the efficacy of using early, intensive ES therapy to prevent post stroke complications in the affected arm. The qualitative aspect of the feasibility study will explore possible barriers and facilitators to protocol adherence.

Project Lead: Dr Joanna Fletcher-Smith

Visit the ESCAPS webpage

The aim of the BISC study was to evaluate whether a group intervention offering support and education based on biopsychosocial principles improved adjustment and mood outcomes in carers of stroke survivors.

Project Lead: Professor Marion Walker

Co-Investigators: Dr Rebecca Fisher, Dr Penny Benford, Dr Eirini Kontou, Dr Shirley Thomas, Dr Joanna Fletcher-Smith

Visit the BISC webpage

The primary aim of the study is to determine whether stroke recovery at home given by a trained family member is an effective, affordable strategy for those with disabling stroke in India when compared to usual care. 

Secondary aims are to determine if Early Supported Discharge with a trained family-led caregiver-delivered, home-based rehabilitation program reduces hospital length of stay; reduces death or dependency (as measured by scores of three to six on the modified Rankin Scale) of people with stroke three months after randomisation; improves patient and caregiver mood at six months; and reduces caregiver burden.

Chief Investigator: Richard Lindley

Local Project Lead: Professor Marion Walker 

Read more about this trial.

East Midlands CLAHRC - Caring for Older People and Stroke Survivors Theme (COPPS)

The aims of this study are to develop a change intervention designed to facilitate the delivery of evidence based stroke rehabilitation in hospitals across the East Midlands.

Project Lead: Professor Marion Walker & Dr Rebecca Fisher

Co-Investigators: Dr Rebecca Fisher, Dr Niki Chouliara, Dr Brian Crosbie, Prof Tom Robinson, Prof Niki Sprigg, Prof Peter Langhorne, Prof Marion Walker. 

This study aimed to uncover the mechanisms that enable or inhibit the implementation of evidence based rehabilitation within "real life" clinical settings with the view to informing improvement strategies.  A realist evaluation approach guided the collection of mixed methods data from four stroke units in the East Midlands region. Despite the observed variability of practice across the four units, common mechanisms driving evidence based care were identified. The explanatory power of these mechanisms has been used to engage teams in evidence based service development.

Find out how to get involved with CLAHRC in the East Midlands. 

This research programme investigated the implementation of Stroke Early Supported Discharge. The aim was to investigate whether the health benefits identified in clinical trials were still evident when Early Supported Discharge services were implemented into local areas.

Project leads: Dr Rebecca Fisher, Professor Marion Walker

NIHR CLAHRC Nottinghamshire, Derbyshire and Lincolnshire (2009−2013)

Stroke Early Supported Discharge is a multidisciplinary team intervention that clinical trials have shown reduces length of hospital stay and reduces risk of death and dependency.  In 2009, many stroke services in the UK were in the process of implementing Early Supported Discharge Services as a result of the National Stroke Strategy 2007. This research aimed to gain clarity around how an Early Supported Discharge service might be organised in practice, test methods to facilitate its implementation and test methods to measure the effectiveness of Early Supported Discharge services.

Consensus on the definition of Early Supported Discharge Services

An agreed definition of Early Supported Discharge following stroke was established amongst all Early Supported Discharge trialists. Consensus was then gained amongst researchers and clinicians on the implementation of community stroke rehabilitation services.

A Consensus on Stroke Early Supported Discharge. Stroke. 2011; 42:1392-1397.

The implementation of evidence based rehabilitation services for stroke survivors living in the community. The results of a Delphi consensus process. Clinical Rehabilitation 2013. 27(8): 741-749

Mapping Early Supported Discharge Services

Semi-structured interviews were completed with stakeholders, commissioners, service providers and allied healthcare professionals to understand the factors influencing the development, organisation and implementation of Early Supported Discharge services in the Nottinghamshire and Northamptonshire regions. Face-to-face interviews were also conducted with patients and their carers.

Implementing evidence-based Stroke Early Supported Discharge services: a qualitative study of challenges, facilitators and impact. Clinical Rehabilitation. 2014. 28(4):370-377  

A qualitative study exploring patients’ and carers’ experiences of Early Supported Discharge Services after stroke. Clinical Rehabilitation. 2013. 27(8): 750-757

Implementation activities

The research team designed and delivered interactive workshops focused on ‘Eligibility for Early Supported Discharge’ and ‘Effective Data handling’ to facilitate evidence based practice.

Implementation of Early Supported Discharge: expectation not icing on the cake.

Evaluation of ESD services: the utility of routine data

Measuring the effectiveness of Early Supported Discharge Services

Two Early Supported Discharge services operating in practice were evaluated; both services had adopted an evidence model (based on consensus documents). Stroke survivors who accessed the evidence based Early Supported Discharge services had significantly shorter length of hospital stay and accelerated improvement in activities of daily living compared to stroke survivors who didn’t access Early Supported Discharge.

Is Stroke Early Supported Discharge still effective in practice? A prospective comparative study. Clinical Rehabilitation. 2015 Mar 31. pii: 0269215515578697

Improving community stroke services across the East Midlands (2013−2015)

This NIHR CLAHRC research informed a two year programme of service improvement activities designed to facilitate the provision of evidence based community stroke care across the East Midlands. Commissioned by the East midlands Academic Health Science Network, this programme involves commissioner support, alignment of performance metrics, delivery of a multidisciplinary team effectiveness programme and improved information provision for stroke survivors. For more information: http://emahsn.org.uk/programmes-and-projects/stroke-rehabilitation/

A trial to compare a neuropsychological approach to dressing, with the conventional approach commonly used by occupational therapists in the UK.

Project lead: Professor Marion Walker

A randomised controlled trial to test if an occupational therapy treatment package could be used to overcome the problems faced by people with stroke who cannot get out of the house.

Project Lead: Professor Pip Logan

A multicentre randomised controlled trial to evaluate whether a psychological treatment, called behaviour therapy, is effective at treating low mood in people with aphasia due to a stroke.

Project lead: Dr Shirley Thomas

Evaluating the feasibility of using a modified Wii system in the home to assist in the rehabilitation of stroke patients with residual upper limb problems.

Project lead: Professor Penny Standen

Determining what people with stroke, their employers and other stakeholders want from vocational rehabilitation services, so that appropriate services can be designed.

Lead: Dr Kate Radford

Illustrating the simple tests which can be used to predict fitness to drive in people with dementia, multiple sclerosis, Parkinson's disease and stroke

Lead: Dr Kate Radford

Evaluating the feasibility of conducting a large multi centre randomised controlled trial of home visits conducted prior to discharge from hospital.

Lead: Professor Avril Drummond

Granulocyte-Colony-Stimulating Factor Mobilizes Bone Marrow Stem Cells in Patients With Subacute Ischemic Stroke: The Stem Cell Trial of Recovery EnhanceMent After Stroke (STEMS)

Loss of motor function is common after stroke and leads to significant chronic disability. Stem cells are capable of self-renewal and of differentiating into multiple cell types, including neurones, glia, and vascular cells. The trial is assessing the safety of granulocyte-colony-stimulating factor (G-CSF) after stroke and its effect on circulating CD34+ stem cells. (Lead: Dr Niki Sprigg) 

Chief Investigator: Dr Niki Sprigg

Can looped nasogastric tube feeding improve feeding in people who can't swallow after a stroke?

Lead: Dr Niki Sprigg