Why is this research needed?
After stroke, around three quarters of people have weakness of their arm and hand (sometimes called the ‘upper limb’). This can have a big impact on stroke survivor’s lives, affecting whether they’re able to prepare food, eat and drink, and put on the clothes they would like to wear.
Clinical guidelines for stroke recommend that stroke survivors receive therapy “for as long as they are willing and capable of participating and showing measurable benefit from treatment” (National Clinical Guideline for Stroke, 2016). However, the majority of stroke survivors don’t receive the support they need. Many also say they’ve been told that they’re unlikely to see any more improvement more than 3-12 months after their stroke.
We don’t know how much rehabilitation is most helpful for stroke survivors. Some researchers think that ‘high-dose, high-intensity’ rehabilitation, where patients receive lots of rehabilitation in a short space of time, can improve life after stroke.
The Queen Square Upper Limb (QSUL) Neurorehabilitation programme was set up in 2014 at a hospital in London. It’s an NHS service which gives stroke survivors high-intensity arm and hand physiotherapy: 90-hours of rehabilitation over three weeks, that’s six hours per day.
The team leading the QSUL programme have found that patient’s arm and hand function can be better at the end of the treatment, even if they had their stroke many years ago.
While these results are promising, we need to find out more about how effective this type of treatment is, and why, before it can be routinely offered on the NHS.
What is the research aiming to do?
This research project aims to provide more and better evidence for how effective the QSUL rehabilitation programme of ‘high-dose, high-intensity’ treatment is at improving stroke survivor’s arm and hand function.
How will they do this?
To investigate the effect of this programme the researchers will carry out a Randomised Controlled Trial (RCT). In an RCT participants are split randomly into two groups:
- One group receives the new treatment – in this case, the QSUL rehabilitation programme.
- One group receives no treatment – the control group. In this study, participants can choose to have the treatment once the researchers have finished all of the tests they need.
This allows the researchers to compare the two groups to tell whether the QSUL rehabilitation programme is improving stroke survivor’s arm and hand function compared to no treatment. To test whether the function has improved the researchers will look at participant’s ability to grasp, grip and pinch using their affected arm and hand.
What benefits could this have for people affected by stroke?
The researchers hope that this project will provide the evidence necessary to decide if intensive arm and hand rehabilitation is recommended in clinical guidelines and offered routinely on the NHS to stroke survivors.
The researchers also hope that this project will tell us whether some stroke survivors are more likely to benefit from this rehabilitation than others. This will help healthcare professionals to give stroke survivors better and more accurate information about the chances of improvement to their arm and hand function.
About the researcher
Dr Tedesco Triccas studied for her degree in physiotherapy at the University of Malta. Since then she’s worked and studied in Malta and the UK, and most recently has been working as a researcher in Belgium.
Lisa hopes that the outcomes of this project will help us to understand more about what the ‘active ingredients’ of this type of treatment are – the part(s) of the treatment that make it effective. This information can then be used to develop new rehabilitation techniques and training programmes in future.
Currently, 45% of people with stroke feel abandoned after they leave hospital. Lisa told us “This type of work is important in rebuilding lives after stroke by providing hope to those who feel they have been abandoned.