Nav: Home

Results from new global health task shifting trial surprise researchers

June 27, 2017

One of the largest stroke rehabilitation trials ever undertaken has revealed family-led rehabilitation is ineffective.

The research published in The Lancet this week revealed there was no reduction in disability for patients on the trial, compared to those who received no extra care.

The results raise serious questions about the benefit of rehabilitation carried out by family members and highlights the need for urgent investment in professional stroke facilities in low and middle income countries.

Lead author Professor Richard Lindley, of The George Institute for Global Health and the University of Sydney, said the results were surprising.

Professor Lindley said: "We had expected to see a marked improvement in recovery of people who received this extra care delivered by their own trained family members, in their own homes. Other trials have indicated that community-based rehabilitation can play a significant role in recovery but these have been conducted largely in high resource settings.

"We found that despite extensive training in hospital and during follow up visits in the home, there was no difference in the degree of recovery or quality of life of people who received this extra treatment. We are confident that the training sessions were completed correctly, and patients and carers accepted the training. Our results suggest that effective rehabilitation may need to be provided by professionals who have undergone years of training and are specialists in their own field, which may impose major challenges to poor communities with limited financial resources."

The George Institute researchers along with international and Indian stroke experts followed 1,250 patients over six months in India, where stroke affects much younger working age people than those in high-income countries (an average of about 15 years younger).

Half were provided with access to professionals, such as physiotherapists, who taught the family techniques such as mobility training and communication practice. Each patient was also visited at their home to ensure the rehabilitation was carried out correctly by their carer.

The intervention more than doubled hospital therapy time, provided additional community training and was associated with about 30 minutes of daily therapy-related activities by the patient and carer in the first month at home.

It is estimated that around 1.6 million people have a stroke in India each year, yet the vast majority receive no formal rehabilitation.

Professor Lindley added: "In many parts of the world, people who have a stroke receive little to no medical treatment at all. In India, there are only 35 stroke units across the whole country, and most are in the cities. In response to the rising rates of stroke there needs to be much greater investment in facilities for people affected by stroke, and measures to protect them from the potentially prohibitive costs of treatment."

Professor Jeyaraj Pandian, the lead Indian neurologist from Christian Medical College, Ludhiana, said: "Many more stroke units are needed in India with more trained professionals who can deliver life changing rehabilitation.

"The ATTEND trial has been very important in building stroke research capacity in India, and stroke research has recently received important new funding from the Indian Council of Medical Research that builds on this success."

It had been hoped the family led care - also known as task shifting (the training of non-healthcare workers to perform tasks traditionally undertaken by the multidisciplinary team) - would help address the limited healthcare access for those with stroke in low and middle income countries. Community rehabilitation is also a priority of the World Health Organisation. The disappointing results of the trial provide important new evidence that task shifting a complex intervention such as rehabilitation may not be effective.

Professor GV Murthy of the Indian Institute of Public Health, the Co-Chair of the study, commented: "Task shifting is increasingly seen as a solution to targeting chronic diseases in many countries in the world. But our results show it may be ineffective for some conditions and waste already limited resources.

"We need more rigorous examinations of such family and community led programs before they become commonplace."
-end-
The ATTEND trial was an international collaboration involving the Universities of Nottingham, Leeds and Glasgow in the UK and University of Sydney and University of New South Wales in Australia. The project was led by The George Institute for Global Health, Sydney, Australia, and funded by the National Health and Medical Research Council of Australia.

George Institute for Global Health

Related Stroke Articles:

Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care
An interactive, digital alarm clock may speed emergency stroke care, starting at hospital arrival and through each step of the time-sensitive treatment process.
Stroke patients with COVID-19 have increased inflammation, stroke severity and death
Stroke patients who also have COVID-19 showed increased systemic inflammation, a more serious stroke severity and a much higher rate of death, compared to stroke patients who did not have COVID-19, according a retrospective, observational, cross-sectional study of 60 ischemic stroke patients admitted to UAB Hospital between late March and early May 2020.
'Time is vision' after a stroke
University of Rochester researchers studied stroke patients who experienced vision loss and found that the patients retained some visual abilities immediately after the stroke but these abilities diminished gradually and eventually disappeared permanently after approximately six months.
More stroke awareness, better eating habits may help reduce stroke risk for young adult African-Americans
Young African-Americans are experiencing higher rates of stroke because of health conditions such as high blood pressure, diabetes and obesity, yet their perception of their stroke risk is low.
How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.
Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.
High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.
Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.
We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.
Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.
More Stroke News and Stroke Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Warped Reality
False information on the internet makes it harder and harder to know what's true, and the consequences have been devastating. This hour, TED speakers explore ideas around technology and deception. Guests include law professor Danielle Citron, journalist Andrew Marantz, and computer scientist Joy Buolamwini.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at Radiolab.org/donate.     You can read The Transition Integrity Project's report here.