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3. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management

Author

Dent, E., Morley, J. E., Cruz-Jentoft, A. J., Woodhouse, L., Rodríguez-Mañas, L., Fried, L. P., Woo, J., Aprahamian, I., Sanford, A., Lundy, J., Landi, F., Beilby, J., Martin, F. C., Bauer, J. M., Ferrucci, L., Merchant, R. A., Dong, B., Arai, H., Hoogendijk, E. O., Won, C. W., Abbatecola, A., Cederholm, T., Strandberg, T., Gutiérrez Robledo, L. M., Flicker, L., Bhasin, S., Aubertin-Leheudre, M., Bischoff-Ferrari, H. A., Guralnik, J. M., Muscedere, J., Pahor, M., Ruiz, J., Negm, A. M., Reginster, J. Y., Waters, D. L., and Vellas, B.

Published
2019
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7. Effect of Glyceryl Trinitrate on Hemodynamics in Acute Stroke

Author

Appleton, J, Woodhouse, L, Bereczki, D, Berge, E, Christensen, H, Collins, R, Gommans, J, Ntaios, G, Ozturk, S, Szatmari, S, Wardlaw, J, Sprigg, N, Rothwell, P, Bath, P, and Investigators, Enos

Subjects
Aged, 80 and over, Male, Time Factors, Original Contributions, Clinical Sciences, blood pressure, Middle Aged, hemodynamics, Administration, Cutaneous, Stroke, Nitroglycerin, glyceryl trinitrate, Acute Disease, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, heart rate, Humans, Female, hemorrhage, Aged
Abstract

Supplemental Digital Content is available in the text., Background and Purpose— Increased blood pressure (BP), heart rate, and their derivatives (variability, pulse pressure, rate-pressure product) are associated with poor clinical outcome in acute stroke. We assessed the effects of glyceryl trinitrate (GTN) on hemodynamic parameters and these on outcome in participants in the ENOS trial (Efficacy of Nitric Oxide in Stroke). Methods— Four thousand and eleven patients with acute stroke and raised BP were randomized within 48 hours of onset to transdermal GTN or no GTN for 7 days. Peripheral hemodynamics were measured at baseline (3 measures) and daily (2 measures) during treatment. Between-visit BP variability over days 1 to 7 (as SD) was assessed in quintiles. Functional outcome was assessed as modified Rankin Scale and cognition as telephone mini-mental state examination at day 90. Analyses were adjusted for baseline prognostic variables. Data are mean difference or odds ratios with 95% CI. Results— Increased baseline BP (diastolic, variability), heart rate, and rate-pressure product were each associated with unfavorable functional outcome at day 90. Increased between-visit systolic BP variability was associated with an unfavourable shift in modified Rankin Scale (highest quintile adjusted odds ratio, 1.65; 95% CI, 1.37–1.99), worse cognitive scores (telephone mini-mental state examination: highest quintile adjusted mean difference, −2.03; 95% CI, −2.84 to −1.22), and increased odds of death at day 90 (highest quintile adjusted odds ratio, 1.57; 95% CI, 1.12–2.19). GTN lowered BP and rate-pressure product and increased heart rate at day 1 and reduced between-visit systolic BP variability. Conclusions— Increased between-visit BP variability was associated with poor functional and cognitive outcomes and increased death 90 days after acute stroke. In addition to lowering BP and rate-pressure product, GTN reduced between-visit systolic BP variability. Agents that lower BP variability in acute stroke require further study.

Published
2019

12. Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD), a UK wide multicentre prospective observational cohort study of cognition after stroke: Protocol

Author

Doubal, F, Brown, R, Backhouse, E, Woodhouse, L, Bath, P, Quinn, T, Robinson, T, Markus, HS, McManus, R, Werring, DJ, O'Brien, John, Sprigg, N, Parry-Jones, A, Touyz, RM, Williams, S, Mah, YH, Emslie, H, Markus, Hugh [0000-0002-9794-5996], O'Brien, John [0000-0002-0837-5080], and Apollo - University of Cambridge Repository

Subjects
Stroke, cognition, observational, dementia
Abstract

Background: Stroke commonly affects cognition and, by definition, much vascular dementia follows stroke. However, there are fundamental limitations in our understanding of vascular cognitive impairment, restricting understanding of prevalence, trajectories, mechanisms, prevention, treatment, and patient service needs. Aims: Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD) is an observational cohort study of post-stroke cognition. We aim to recruit a wide range of patients with stroke, presenting to geographically diverse UK hospitals, into a longitudinal study to determine rates of, and risk factors for, cognitive and related impairments after stroke, to assess potential mechanisms and improve prediction models. Methods: We will recruit at least 2000 patients within six weeks of stroke with or without capacity to consent, and collect baseline demographic, clinical, socioeconomic, lifestyle, cognitive, neuropsychiatric and informant data using streamlined patient centred methods appropriate to the stage after stroke. We will obtain more detailed assessments at 4-8 weeks after the baseline assessment and follow-up by phone and post yearly to at least 2 years. We will assess diagnostic neuroimaging in all, and high-sensitivity inflammatory markers, genetics, blood pressure (BP) and diffusion tensor imaging in mechanistic sub-studies. Planned Outputs: R4VaD will provide reliable data on long-term cognitive function after stroke, stratified by prior cognition, stroke- and patient-related variables, and improved risk prediction. It will create a platform enabling sharing of data, imaging and samples. Participants will be consented for re-contact, facilitating future clinical trials, and providing a resource for the stroke and dementia research communities.

Published
2021

13. Rates, risks and routes to reduce vascular dementia (R4vad), a UK-wide multicentre prospective observational cohort study of cognition after stroke:Protocol

Author

Wardlaw, J.M., Doubal, F., Brown, R., Backhouse, E., Woodhouse, L., Bath, P., Quinn, T.J., Robinson, T., Markus, H.S., McManus, R., O’Brien, J.T., Werring, D.J., Sprigg, N., Parry-Jones, A., Touyz, R.M., Williams, S., Mah, Y.-H., Emsley, H., Investigators, the R4VaD, Wardlaw, J.M., Doubal, F., Brown, R., Backhouse, E., Woodhouse, L., Bath, P., Quinn, T.J., Robinson, T., Markus, H.S., McManus, R., O’Brien, J.T., Werring, D.J., Sprigg, N., Parry-Jones, A., Touyz, R.M., Williams, S., Mah, Y.-H., Emsley, H., and Investigators, the R4VaD

Abstract

Background: Stroke commonly affects cognition and, by definition, much vascular dementia follows stroke. However, there are fundamental limitations in our understanding of vascular cognitive impairment, restricting understanding of prevalence, trajectories, mechanisms, prevention, treatment and patient-service needs. Aims: Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD) is an observational cohort study of post-stroke cognition. We aim to recruit a wide range of patients with stroke, presenting to geographically diverse UK hospitals, into a longitudinal study to determine rates of, and risk factors for, cognitive and related impairments after stroke, to assess potential mechanisms and improve prediction models. Methods: We will recruit at least 2000 patients within six weeks of stroke with or without capacity to consent and collect baseline demographic, clinical, socioeconomic, lifestyle, cognitive, neuropsychiatric and informant data using streamlined patient-centred methods appropriate to the stage after stroke. We will obtain more detailed assessments at four to eight weeks after the baseline assessment and follow-up by phone and post yearly to at least two years. We will assess diagnostic neuroimaging in all and high-sensitivity inflammatory markers, genetics, blood pressure and diffusion tensor imaging in mechanistic sub-studies. Planned outputs: R4VaD will provide reliable data on long-term cognitive function after stroke, stratified by prior cognition, stroke- and patient-related variables and improved risk prediction. It will create a platform enabling sharing of data, imaging and samples. Participants will be consented for re-contact, facilitating future clinical trials and providing a resource for the stroke and dementia research communities. © European Stroke Organisation 2020.

Published
2021

14. Rates, risks and routes to reduce vascular dementia (R4vad), a UK-wide multicentre prospective observational cohort study of cognition after stroke : Protocol

Author

Wardlaw, J.M., Doubal, F., Brown, R., Backhouse, E., Woodhouse, L., Bath, P., Quinn, T.J., Robinson, T., Markus, H.S., McManus, R., O’Brien, J.T., Werring, D.J., Sprigg, N., Parry-Jones, A., Touyz, R.M., Williams, S., Mah, Y.-H., Emsley, H., Investigators, the R4VaD, Wardlaw, J.M., Doubal, F., Brown, R., Backhouse, E., Woodhouse, L., Bath, P., Quinn, T.J., Robinson, T., Markus, H.S., McManus, R., O’Brien, J.T., Werring, D.J., Sprigg, N., Parry-Jones, A., Touyz, R.M., Williams, S., Mah, Y.-H., Emsley, H., and Investigators, the R4VaD

Abstract

Background: Stroke commonly affects cognition and, by definition, much vascular dementia follows stroke. However, there are fundamental limitations in our understanding of vascular cognitive impairment, restricting understanding of prevalence, trajectories, mechanisms, prevention, treatment and patient-service needs. Aims: Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD) is an observational cohort study of post-stroke cognition. We aim to recruit a wide range of patients with stroke, presenting to geographically diverse UK hospitals, into a longitudinal study to determine rates of, and risk factors for, cognitive and related impairments after stroke, to assess potential mechanisms and improve prediction models. Methods: We will recruit at least 2000 patients within six weeks of stroke with or without capacity to consent and collect baseline demographic, clinical, socioeconomic, lifestyle, cognitive, neuropsychiatric and informant data using streamlined patient-centred methods appropriate to the stage after stroke. We will obtain more detailed assessments at four to eight weeks after the baseline assessment and follow-up by phone and post yearly to at least two years. We will assess diagnostic neuroimaging in all and high-sensitivity inflammatory markers, genetics, blood pressure and diffusion tensor imaging in mechanistic sub-studies. Planned outputs: R4VaD will provide reliable data on long-term cognitive function after stroke, stratified by prior cognition, stroke- and patient-related variables and improved risk prediction. It will create a platform enabling sharing of data, imaging and samples. Participants will be consented for re-contact, facilitating future clinical trials and providing a resource for the stroke and dementia research communities. © European Stroke Organisation 2020.

Published
2021

25. Pre-operative predictors of the likelihood of achieving a composite measure of net benefit from total knee arthroplasty in people with knee osteoarthritis

Author

Hawker, G.A., primary, Bohm, E., additional, Dunbar, M., additional, Faris, P., additional, Jones, C.A., additional, Noseworthy, T., additional, Ravi, B., additional, Woodhouse, L., additional, Dick, D., additional, Paul, P., additional, Powell, J., additional, Adachi, A.-M., additional, Depew, J., additional, Stanaitis, I., additional, Hill, D., additional, Howden, J. Squire, additional, Reczek, T., additional, and Marshall, D.A., additional

Published
2020
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26. Testosterone effects on the skeletal muscle

Author

Bhasin, S., primary, Storer, T.W., additional, Singh, A.B., additional, Woodhouse, L., additional, Singh, R., additional, Artaza, J., additional, Taylor, W.E., additional, Sinha-Hikim, I., additional, Jasuja, R., additional, and Gonzalez-Cadavid, N., additional

Published
2001
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28. Physical frailty:ICFSR international clinical practice guidelines for identification and management

Author

Dent, E. (E.), Morley, J. E. (J. E.), Cruz-Jentoft, A. J. (A. J.), Woodhouse, L. (L.), Rodríguez-Mañas, L. (L.), Fried, L. P. (L. P.), Woo, J. (J.), Aprahamian, I. (I.), Sanford, A. (A.), Lundy, J. (J.), Landi, F. (F.), Beilby, J. (J.), Martin, F. C. (F. C.), Bauer, J. M. (J. M.), Ferrucci, L. (L.), Merchant, R. A. (R. A.), Dong, B. (B.), Arai, H. (H.), Hoogendijk, E. O. (E. O.), Won, C. W. (C. W.), Abbatecola, A. (A.), Cederholm, T. (T.), Strandberg, T. (T.), Gutiérrez Robledo, L. M. (L. M.), Flicker, L. (L.), Bhasin, S. (S.), Aubertin-Leheudre, M. (M.), Bischoff-Ferrari, H. A. (H. A.), Guralnik, J. M. (J. M.), Muscedere, J. (J.), Pahor, M. (M.), Ruiz, J. (J.), Negm, A. M. (A. M.), Reginster, J. Y. (J. Y.), Waters, D. L. (D. L.), Vellas, B. (B.), Dent, E. (E.), Morley, J. E. (J. E.), Cruz-Jentoft, A. J. (A. J.), Woodhouse, L. (L.), Rodríguez-Mañas, L. (L.), Fried, L. P. (L. P.), Woo, J. (J.), Aprahamian, I. (I.), Sanford, A. (A.), Lundy, J. (J.), Landi, F. (F.), Beilby, J. (J.), Martin, F. C. (F. C.), Bauer, J. M. (J. M.), Ferrucci, L. (L.), Merchant, R. A. (R. A.), Dong, B. (B.), Arai, H. (H.), Hoogendijk, E. O. (E. O.), Won, C. W. (C. W.), Abbatecola, A. (A.), Cederholm, T. (T.), Strandberg, T. (T.), Gutiérrez Robledo, L. M. (L. M.), Flicker, L. (L.), Bhasin, S. (S.), Aubertin-Leheudre, M. (M.), Bischoff-Ferrari, H. A. (H. A.), Guralnik, J. M. (J. M.), Muscedere, J. (J.), Pahor, M. (M.), Ruiz, J. (J.), Negm, A. M. (A. M.), Reginster, J. Y. (J. Y.), Waters, D. L. (D. L.), and Vellas, B. (B.)

Abstract

Objective: The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. Methods: These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are pr

Published
2019

41. A012 – CURRENT UTILIZATION OF AEROBIC EXERCISE IN ADULT NEUROLOGICAL REHABILITATION BY CANADIAN PHYSIOTHERAPISTS

Author

Mehta, SP, MacDermid, JC, Butcher, SJ, Pikaluk, BJ, Heynen, NM, Chura, RL, Farthing, JP, Marciniuk, DD, MacKay-Lyons, M, Doyle, L, MacDonald, T, Law, M, Burgos-Martinez, G, Fleet, A, Che, M, MacKenzie, D, Page, S, Boe, S, Woznowski-Vu, A, Preuss, R, Shaw, JA, Connelly, DM, McWilliam, CL, Shaw, J, Sidhu, K, Kearney, C, Keeber, M, McKay, S, Hopkins-Rosseel, D, Bergsma, K, Van Bavel, C, Fricke, M, Swinamer, J, Winn, CS, Tryssenaar, J, Chisholm, BA, Hummelbrunner, JA, Kandler, LS, Jasper, L, Daniels, J, Haennel, RG, Johnson, R, Martin, B, Norman, KE, Booth, R, Chisholm, B, Ellerton, C, Jelley, W, MacPhail, A, Mooney, P, Mori, B, Taipalus, L, Thomas, B, Duval, G, Ghali, S, Nasirian, A, Santillo, G, Yang, XL, Thomas, A, McKinley, P, Kaizer, F, Desveaux, L, Nanavaty, G, Howell, P, Sundar, R, Ryan, J, Verrier, M, Dutton, TL, Langendoen, T, Marshall, J, Coghill, C, Pederson, C, Blechinger, C, Marshall, M, Hamilton, CB, Chesworth, BM, Styles-Tripp, F, Sheps, D, Bury, J, Bouliane, M, Glasgow, R, Otto, D, Luciak-Corea, C, Beaupre, L, Balyk, R, Carson, S, Graham, J, Hopman, W, Parsons, T, Sawant, A, Overend, T, Prasanna, SS, Korner-Bitensky, N, Ahmed, S, O’Donovan, MJ, Driver, H, Randhawa, BK, Farley, BG, Boyd, LA, Henderson, R, Najafi, B, Bansberg, J, Druja, G, Hinch, S, Sikkema, A, Subramanian, SK, LourenÇo, CB, Chilingaryan, G, Sveistrup, H, Levin, MF, King, J, Chamberland, P, Agar, A, Leger, R, Michaels, R, Poitras, R, Rawji, A, Skelton, D, Warren, M, Lavallée, L, LeBlanc, C, McKim, D, Woolnough, A, Cockburn, L, Wango, J, Benuh, E, Cleaver, S, Madill, SJ, Pontbriand-Drolet, S, Prud’homme-Delage, A, Tang, A, Dumoulin, C, Hiemstra, LA, Lafave, M, Kerslake, S, Heard, M, Buchko, G, Mohtadi, N, Auais, M, Eilayyan, O, Mayo, N, Otfinowski, C, Fung, J, Smallhorn, P, Diez, d’Aux N, Shan, He F, Li, L, Ren, Y, Perez, C, Spahija, J, Sadeghi, M, Ebrahimi, S, Maroufi, N, Jamshidi, AA, Chepeha, JC, Magee, DJ, Warren, S, Storey, AST, Brinkman, DM, Bauck, RA, Myrah, AM, Friess, SN, Webber, SC, Taphorn, A, Magnus, CRA, Arnold, CM, Johnston, G, Dal-Bello, Haas V, Basran, J, Krentz, JR, Berardi, D, Brizard, M, Brière, H, Charron, M, Gagnon, I, Tran, T, Kasymjanova, G, Grossman, M, Xenopoulos, T, Jagoe, T, Agulnik, J, Small, D, Kinlin, C, Marlow, T, Donald, LA, Tiessen, S, Cooper, N, Pryse-Phillips, S, Yoshida, K, Teachman, G, Wright, V, Fehlings, D, Young, N, McKeever, P, Parent, EC, Breitkreitz, R, Ladd, J, McIntosh, K, Pauls, D, Urhbach, S, Koppenhaver, S, Alderdice, C, Evans, J, Feldman, S, Robinson, S, White, L, Long, A, McDougall, M, Bonnet, F, Brososky, C, Hopcroft, L, Bester, L, Clement, D, Quigley, A, Sachdeva, M, Rourke, S, Nixon, S, Mendes, P, Robles, P, Mathur, S, Warmington, K, Kennedy, C, Lundon, K, Rozmovits, L, Lineker, S, Shupak, R, Schneider, R, Kennedy, CA, Soever, L, Passalent, L, Katie, Lundon K, Roots, RK, Bainbridge, L, Brown, H, Li, LC, Gillis, K, Augruso, A, Coe, T, O’Neill, A, Radford, L, Gibson, BE, O’Callaghan, L, Bath, B, Janzen, B, Lovo, Grona S, Bourassa, R, Reilly, J, Prendergast, M, Derbyshire, M, Anderson, CM, Friedman, D, Gilbert, G, Lazowski, D, Hurtubise, K, Cote, N, McGlasson, Emery, C, Woodhouse, L, Jones, A, Dickinson, D, Torrance, G, Landry, MD, Murphy, SM, Rivard, LM, Levac, D, Aisen, M, French, EH, Barclay-Goddard, R, Dubouloz, CJ, Schwartz, CE, Jam, B, Manns, PJ, McDonald, A, Ploughman, M, Evans, C, Zhan, J, Stevens, M, Asmundson, Gordon, Yardley, D, Funk, S, Yeung, E, Sinclair, L, Damp, Lowery C, Denehy, L, Ziegler, T, LaRocque, D, Clarke, L, Edge-Hughes, LM, Budiselic, S, Berney, S, Rankin, A, Juricic, M, Peddie, E, Johnson, A, and Seminowicz, DA

Subjects
Innovation in Education, Practice Models and Policy, Divisions, Abstracts, CPA Congress 2012, Proposals, Guest Editorial, Physiotherapy Research: Basic Science through Population Health, Best Practice
Published
2012

42. A032 – Health, lifestyle and aging with Multiple Sclerosis: A qualitative study

Author

Arnold, Catherine M., Faulkner, Robert A., Ploughman, Michelle, Austin, Mark, Kearney, Anne, Murdoch, Michelle, Stefanelli, Mark, Godwin, Marshall, Muir, Susan W, Speechley, Mark, Borrie, Michael, Montero-Odasso, Manuel, MacKay-Lyons, M, Creaser, G, Macdonald, A, McKenna, J, Murphy, S, O'Neill, VR, Nilsson, T, Begley, L, Ikert, Kathy M., Long, Kristin M., Bittner, Darren R., Birmingham, Trevor B., Bryant, Dianne M., Richardson, Julie, Letts, Lori, Chan, David, Stratford, Paul, Hand, Carri, Price, David, Hilts, Linda, Coman, Liliana, Edwards, Mary, Baptiste, Sue, Law, Mary, Alexander, Elliot, Rosenthal, Stephanie, Guilcher, Sara, Evans, Cathy, Gattey, M, Hydomako, R, McLean, B, O'Leary, J, Shkopich, K, Klassen, L, Laprade, Judi, Roy, Marla, Laing, M, Di Nicolantonio, L, Goncharova, K, Pui, M, Vas, H, House, R, Switzer-McIntyre, S, Cheifetz, O, Serediuk, F, Park Dorsay, J, Hladysh, G, Woodhouse, L, Dalzell, MA, Shallwani, S, Preuss, RA, Patterson, Debbie, Ptak, Janice, Howe, JA, Brunton, K, Salisbury, K, Sharma, SK, Childerhose, DE, Sharma, S, WalkerJohnston, JA, Barnes, JL, Fisher, Megan E., Aristone, Martha N., Young, Katrina K., Waechter, Laurie E., Landry, Michel D., Taylor, Leslie A., Cooper, Nicole S., Wong, S, Hébert, Luc J., Rowe, Peter, Debouter, Kelly, Lai, Denise, Winn, CS, Chisholm, BA, Hummelbrunner, JA, Wasson, Pamela, Passalent, L, Soever, L, Kennedy, C, Warmington, K, Shupak, R, Thomas, R, Linekar, S, Lundon, K, Morgan, Dale, Kelly, Larry, Hastie, Robyn, Deber, Raisa B., Verrier, Molly C., O'Callaghan, L, Alexander, E, Titus, D, MacDougall, P, Hoens, AM, Garland, SJ, Tunnacliffe, R, Lineker, S, Varatharasan, N, Schneider, R, MacKay, C, Murphy, SM, Wu, Kenneth, Fox, Patricia, Tullis, Elizabeth, Stephenson, Anne L., Davis, AM, Mahomed, N, Badley, EM, Scott, Lisa, Carpenter, Christine, Brander, Rosemary R., Paterson, Margo L., Chan, Yolande E., Reinikka, KJE, French, E, Huijbregts, M, Cleaver, SR, Paulenko, T, Hebert, D, Creaser, GA, MacKenzie, D, Barkhouse-McKeen, C, Shrier, Ian, Freeman, K, Davidson, L, Pelland, L, Wilson, Nicole, Hopkins-Rosseel, Diana, Fraser, M, Wainwright, G, MacCormack, B, Basque Godin, C, Mori, B, Evans, C, Gibson, BE, Thornton, M, Dutton, T, King, J, Lawrence, PJ, Duggan, M, Hoens, A, Geddes, E Lynne, Gill, Caroline, Fong-Lee, Dianna, Lindsay, Jane, McPhail, Stacey, McIntosh, Karen, Marken, Suri L., Dutton, Tanya, Hopkins-Rosseel, DH, Kasdan, P, Fong-Lee, D., Marken, Siri, Moreside, JM, McGill, SM, Juma, S, Winter Di Cola, JL, Kennedy, DM, Dickson, P, Denis, S, Robarts, S, Gollish, J, Salbach, NM, Veinot, P, Jaglal, SB, Bayley, M, Rolfe, D, Dogra, M, Woodhouse, LJ, Spadoni, GF, Stratford, PW, Fox, P, Sessford, J, Beaton, D, Harniman, E, Inrig, T, Baxter, K, Portanova, A, Smuck, L, Connelly, DM, Shaw, J, Adkin, A, Jog, M, Hollway, D, Earl, M, Murphy, A, MacDonald, E, Overend, TJ, Brooks, D, Anderson, CM, Cicutto, L, Keim, M, McAuslan, D, Nonoyama, M, Levac, D., Pierrynowski, M., MacPherson, M, Glassman, L, Jadan, P, MacArthur, L, Landry, M, Frenette, J, Dumont, N, Moreland, JD, DePaul, VG, DeHueck, AL, Musselman, KE, Yang, JF, Tousignant, M, Moffet, H, Boissy, P, Corriveau, H, Cabana, F, Marquis, F, Towns, Megan, Barrett, Lauren, Darling, Catherine, Lee, Michelle, Aganon, Isabel, Hill, Kylie, Brooks, Dina, Robbins, Shawn, Alcock, Greg, Maly, Monica, Jones, Gareth, Birmingham, Trevor, Glazebrook, Cheryl M., Wright, F. Virginia, Martin, MBA, Norton, B, Ramsaran, KD, Street, ME, Syed, SN, Dang, MT, Barclay-Goddard, R, Stratford, P, Miller, P, Karam, J., Zettel, M., Green, K., Carter, D., Lam, F., Evans, C., Yeung, E., Lindquist, NJ, Magis, TF, Rispin, JE, Walton, PE, Kirby, RL, Manns, PJ, Haller, MK, Marler, K, Lore, S, Sottana, B, Crowley, A, Beaudin, V, Sloan, C, Landry, SC, Nigg, BM, Tecante, KE, Albers, Pamela, Devon, Heidi, Nairn, Lacey, Olenick, Betsy, Roach, Stephanie, Arnold, Cathy, Watts, Cathy, Wieler, M, Jones, CA, Allen, J, Haennel, R, Shaw, JA, Zecevic, A, Dal Bello-Haas, V, Harrision, L, Kanthan, R, Lawson, S, Zaluski, N, Petrie, A, Rohs, J, Parker, R, Roy, JS, MacDermid, JC, Roth, JH, Grewal, R, Officer, Alexis, DePaul, Vincent, Bosch, Jackie, Wilkins, Seanne, Wishart, Laurie, Inness, EL, Mansfield, A, Biasin, L, Prajapati, S, Lakhani, B, Mileris, R, McIlroy, WE, Henderson, RJ, Vanik, J, Alyoshkina, N, Diamond, C, Lee, J, Martinov, K, O'Brien, KK, Alexander, R, King, K, Murray, J, Tebeje, M, Bayoumi, AM, Bereket, T, Swinton, M, Norman, G, Solomon, P, Anstey, S, Bethune, M, Thomas, A, Wood-Salomon, E, Curwin, S, D'Amboise, SN, Héroux, ME, Pari, G, Norman, KE, Lee, Linda-Joy, Coppieters, Michel W., Hodges, Paul W., Perreault, Audrey, Tremblay, Louis E., Thibault-Gagnon, S, Gentilcore-Saulnier, E, McLean, L, Kay, JL, McNeely, ML, Campbell, KL, Peddle, CJ, Courneya, KS, Subramanian, SK, Levin, MF, Dechman, G, Tupper, SM, Levesque, L, Reese, H, Nailer, T, Walton, D, Schachter, CL, Stalker, CA, Teram, E, Lasiuk, G, Bartlett, Doreen, Chiarello, Lisa, Jacobs, Diane, Busch, Angela, Novak, Christine B., Anastakis, Dimitri J., Beaton, Dorcas E., Mackinnon, Susan E., Katz, Joel, Figueiredo, S, Finch, L, Jiali, M, Ahmed, S, Huang, A, Mayo, NE, Lochhead, Lois, MacMillan, Peter, DePaul, V, Burridge, H, Kwok, C, Rosario, J, Stogios, C, McKay, E, Moyer, E, Wishart, L, Holly, J, DYER, Joseph-Omer, MAUPAS, Éric, de ANDRADE MELO, Sibele, BOURBONNAIS, Daniel, FORGET, Robert, Shrier, I, Boudier-Reveret, M, Feldman, D, Mazer, B, Rege, SS, Soever, LJ, Fenety, Anne, Hoens, Alison, Harman, Katherine, Bassett, Raewyn, Byrne, Jeannette M., Prentice, Stephen D., Carlesso, Lisa, Cairney, John, Hoogenes, Jennifer, Gabison, S, Nussbaum, EL, Taillon-Hobson, A., McLean, L., Aaron, S., Bilodeau, M., Taillon-Hobson, Anne, McLean, Linda, Aaron, Shawn, Bilodeau, Martin, Zbarsky, Kathryn, Parsley, Dana, Clegg, Heather, Welch, Tyler, Fernandes, Catherine, Jaglal, Susan, Inness, Liz, Williams, Josh, McIlroy, William, Howe, Jo-Anne, Yardley, D, Benoit, M, Blake, T, Gillies, G, Ho, R, MacKinnon, M, Chesworth, BM, Busch, AJ, Dooley, A, Coons, S, Crockett, K, Mucha, J, Kean, CO, Birmingham, TB, King, LK, Giffin, JR, Lourenço, Christiane B., Subramanian, Sandeep, Sveistrup, Heidi, Levin, Mindy F., DESMEULES, FRANÇOIS, DIONNE, CLERMONT E., BELZILE, ÉTIENNE L., BOURBONNAIS, RENÉE, FRÉMONT, PIERRE, Richards, CL, Schneider, GM, Smith, AD, Bath, B, Bourassa, R, Lovo Grona, S, Schneider, KJ, Emery, Carolyn, Norman, Kathleen, Pearson, Neil, Woodhouse, Linda, Pelland, Lucie, Werstine, Rob, and Schneider, Kathryn

Subjects
active transfer strategies for informing clinical practice through information technologies, injury prevention, health human resources management strategies, Merging Research and Practice, implementation and management strategies, Abstracts, clinical experience, clinical skills and clinical reasoning modules in orthopaedic practice, Special Sessions, evolving physiotherapist roles, chronic disease prevention, neurological, basic science or clinically focused research on targeted physiotherapy interventions, Scientific sessions, fundamental scientific research, mobility, Newfoundland, Canadian Physiotherapy Association Congress 2010, population health services, advances in research related to neuromusculoskeletal practice, health system reform, patient and client preference, clinical research and the reciprocal transfer of knowledge between clinical practice and research, innovative service delivery models, post-operative management of acute care patients, promotion of research, practice and patient/client care in the neuromusculoskeletal area, Canada, assessment and treatment of disability that arises from both spinal and peripheral pathologies, Abstracts, CPA Congress 2010, role of physiotherapists in primary health care, exercise prescription, Physical Therapy, Sports Therapy and Rehabilitation, Health Promotion, clinical decision making, St. John's, evidence based practice model, informing the development of clinical research questions, determinants of health, innovative models of practice, physiotherapy leadership development, Physio10, Leadership in Action, public and patient education, musculoskeletal, benchmarking areas of practice, inter-professional collaboration and education strategies, Neuromusculoskeletal Practice, public, private and independent practice management of physiotherapy services, Merging Research with Practice, cardio-respiratory
Published
2010
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46. Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): A partial-factorial randomised controlled trial

Author

Bath, Pm, Woodhouse, L, Scutt, P, Krishnan, K, Wardlaw, Jm, Bereczki, D, Sprigg, N, Berge, E, Beridze, M, Caso, V, Chen, C, Christensen, H, Collins, R, EL ETRIBI, A, Laska, Ac, Lees, Kr, Ozturk, S, Phillips, S, Pocock, S, DE SILVA HA, Szatmari, S, Utton, S, ENOS Trial Investigators, Carolei, Antonio, and Sacco, Simona

Subjects
Male, Vasodilator Agents, 030204 cardiovascular system & hematology, Nitric oxide, law.invention, Brain Ischemia, Brain ischemia, 03 medical and health sciences, chemistry.chemical_compound, Nitroglycerin, 0302 clinical medicine, Randomized controlled trial, Modified Rankin Scale, law, 80 and over, Odds Ratio, Medicine, Aged, Aged, 80 and over, Antihypertensive Agents, Cerebral Hemorrhage, Disease Management, Female, Humans, Hypertension, Middle Aged, Recovery of Function, Single-Blind Method, Stroke, Treatment Outcome, Medicine (all), cardiovascular diseases, business.industry, General Medicine, Odds ratio, medicine.disease, 3. Good health, Mean blood pressure, Blood pressure, chemistry, Anesthesia, business, 030217 neurology & neurosurgery
Abstract

Background: High blood pressure is associated with poor outcome after stroke. Whether blood pressure should be lowered early after stroke, and whether to continue or temporarily withdraw existing antihypertensive drugs, is not known. We assessed outcomes after stroke in patients given drugs to lower their blood pressure.Methods: In our multicentre, partial-factorial trial, we randomly assigned patients admitted to hospital with an acute ischaemic or haemorrhagic stroke and raised systolic blood pressure (systolic 140–220 mm Hg) to 7 days of transdermal glyceryl trinitrate (5 mg per day), started within 48 h of stroke onset, or to no glyceryl trinitrate (control group). A subset of patients who were taking antihypertensive drugs before their stroke were also randomly assigned to continue or stop taking these drugs. The primary outcome was function, assessed with the modified Rankin Scale at 90 days by observers masked to treatment assignment. This study is registered, number ISRCTN99414122.Findings: Between July 20, 2001, and Oct 14, 2013, we enrolled 4011 patients. Mean blood pressure was 167 (SD 19) mm Hg/90 (13) mm Hg at baseline (median 26 h [16–37] after stroke onset), and was significantly reduced on day 1 in 2000 patients allocated to glyceryl trinitrate compared with 2011 controls (difference −7·0 [95% CI −8·5 to −5·6] mm Hg/–3·5 [–4·4 to −2·6] mm Hg; both pInterpretation: In patients with acute stroke and high blood pressure, transdermal glyceryl trinitrate lowered blood pressure and had acceptable safety but did not improve functional outcome. We show no evidence to support continuing prestroke antihypertensive drugs in patients in the first few days after acute stroke.Funding: UK Medical Research Council.

Published
2015
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47. Post-stroke dysphagia: A review and design considerations for future trials

Author

Cohen, D.L, Roffe, C, Beavan, J, Blackett, B, Fairfield, C.A, Hamdy, S, Havard, D, McFarlane, M, McLauglin, C, Randall, M, Robson, K, Scutt, P, Smith, C, Smithard, D, Sprigg, N, Warusevitane, A, Watkins, Caroline Leigh, Woodhouse, L, Bath, P.M, Cohen, D.L, Roffe, C, Beavan, J, Blackett, B, Fairfield, C.A, Hamdy, S, Havard, D, McFarlane, M, McLauglin, C, Randall, M, Robson, K, Scutt, P, Smith, C, Smithard, D, Sprigg, N, Warusevitane, A, Watkins, Caroline Leigh, Woodhouse, L, and Bath, P.M

Abstract

Post-stroke dysphagia (a difficulty in swallowing after a stroke) is a common and expensive complication of acute stroke and is associated with increased mortality, morbidity, and institutionalization due in part to aspiration, pneumonia, and malnutrition. Although most patients recover swallowing spontaneously, a significant minority still have dysphagia at six months. Although multiple advances have been made in the hyperacute treatment of stroke and secondary prevention, the management of dysphagia post-stroke remains a neglected area of research, and its optimal management, including diagnosis, investigation and treatment, have still to be defined.

Published
2016

48. Effect of Treatment Delay, Stroke Type, and Thrombolysis on the Effect of Glyceryl Trinitrate, a Nitric Oxide Donor, on Outcome after Acute Stroke: A Systematic Review and Meta-Analysis of Individual Patient from Randomised Trials

Author

Bath, PM, Woodhouse, L, Krishnan, K, Anderson, C, Berge, E, Ford, GA, Robinson, TG, Saver, JL, Sprigg, N, Wardlaw, JM, Bath, PM, Woodhouse, L, Krishnan, K, Anderson, C, Berge, E, Ford, GA, Robinson, TG, Saver, JL, Sprigg, N, and Wardlaw, JM

Abstract

Background. Nitric oxide (NO) donors are a candidate treatment for acute stroke and two trials have suggested that they might improve outcome if administered within 4-6 hours of stroke onset. We assessed the safety and efficacy of NO donors using individual patient data (IPD) from completed trials. Methods. Randomised controlled trials of NO donors in patients with acute or subacute stroke were identified and IPD sought from the trialists. The effect of NO donor versus control on functional outcome was assessed using the modified Rankin scale (mRS) and death, by time to randomisation. Secondary outcomes included measures of disability, mood, and quality of life. Results. Five trials (4,197 participants) were identified, all involving glyceryl trinitrate (GTN). Compared with control, GTN lowered blood pressure by 7.4/3.3 mmHg. At day 90, GTN did not alter any clinical measures. However, in 312 patients randomised within 6 hours of stroke onset, GTN was associated with beneficial shifts in the mRS (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.34-0.78) and reduced death (OR 0.32, 95% CI 0.14-0.78). Conclusions. NO donors do not alter outcome in patients with recent stroke. However, when administered within 6 hours, NO donors might improve outcomes in both ischaemic and haemorrhagic stroke.

Published
2016

49. Baseline characteristics of the 4011 patients recruited into the ‘Efficacy of Nitric Oxide in Stroke’ (ENOS) trial

Author

Bath, P. M. W., Adami, A., Bereczki, D., Berge, E., Beridze, M., Cala, L., Casado, A., Caso, V., Chang, H. M., Christensen, H., Collins, R., Czlonkowska, A., Dineen, R. A., Etribi, A. E., Ghani, A., Gommans, J., Koumellis, P., Laska, A. C., Lees, K. R., Navarro, J., Ntaios, G., Ozturk, S., Phillips, S., Pocock, S., Prasad, K., Scutt, P., de Silva, H. A., Szatmari, S., Exuperio, Diez-Tejedor, Utton, S., Wang, Y. -J., Wardlaw, Joanna M., Whynes, D., Wong, L., Woodhouse, L., Sprigg, N., Enos, Investigators, Sacco, S., and Selçuk Üniversitesi

Subjects
Male, Vasodilator Agents, RATIONALE, BLOOD-PRESSURE, Blood Pressure, STATISTICAL-ANALYSIS, Severity of Illness Index, law.invention, Brain Ischemia, chemistry.chemical_compound, Nitroglycerin, glyceryl trinitrate, DESIGN, Randomized controlled trial, Enos, law, 80 and over, Medicine, Single-Blind Method, ACUTE ISCHEMIC-STROKE, Prospective Studies, Prospective cohort study, Stroke, SCALE, Aged, 80 and over, OUTCOMES, biology, blood pressure, Middle Aged, Treatment Outcome, Neurology, Anesthesia, antihypertensive drugs, Administration, Female, Adult, medicine.medical_specialty, acute stroke, Administration, Cutaneous, CLINICAL-TRIAL, Nitric oxide, Young Adult, nitric oxide, Internal medicine, Severity of illness, Humans, TRANSDERMAL GLYCERYL TRINITRATE, Antihypertensive Agents, Aged, Cerebral Hemorrhage, business.industry, biology.organism_classification, medicine.disease, Clinical trial, Blood pressure, Cutaneous, chemistry, randomized controlled trial, business, Acute stroke, Antihypertensive drugs, Glyceryl trinitrate
Abstract

WOS: 000339477400012, PubMed: 25043647, Background High blood pressure is common in acute stroke and associated with a worse functional outcome. Many patients who present with acute stroke are taking prescribed antihypertensive therapy before their stroke. Aims ENOS tested whether lowering blood pressure and continuing pre-stroke antihypertensive therapy are each safe and effective. Methods This study is an international multi-centre prospective randomized single-blind blinded-endpoint parallel-group partial-factorial controlled trial of transdermal glyceryl trinitrate (a nitric oxide donor, given for seven-days) vs. no glyceryl trinitrate, and of continuing vs. stopping (temporarily for seven-days) pre-stroke antihypertensive drugs if relevant, in patients with acute ischaemic stroke or intracerebral haemorrhage and high systolic blood pressure (140-220 mmHg). Results Recruitment ran from July 2001 to October 2013. Four thousand eleven patients [2097 (52.3%) in the continue/stop arm] were recruited from 173 sites across 23 countries in 5 continents (Asia 14%, Continental Europe 16%, UK 64%). Baseline characteristics include: mean age 70 (standard deviation 12) years; male 57%; mean time from stroke to recruitment 26 (13) h; mean severity (Scandinavian Stroke Scale) 34 (13) of 58; mean blood pressure 167 (19)/90 (13) mmHg; ischaemic stroke 83%; and intracerebral haemorrhage 16%. The main trial results will be presented in May 2014. The results will also be presented in updated Cochrane systematic reviews and included in individual patient data meta-analyses of all relevant randomized controlled trials. Conclusion ENOS is a large completed international trial of blood pressure management in acute stroke and includes patients representative of many stroke services worldwide., UK Medical Research CouncilMedical Research Council UK (MRC); Bupa Foundation; Hypertension Trust; Queen Elizabeth II Health Sciences Centre Research Fund; Reichstadt family; Stroke Association; UK NIHR, through the Stroke Research Network, We thank all the patients, and their carers, for participating in the trial. The UK Medical Research Council was the primary funder; we thank them and other funders who supported the trial: A Star, Bupa Foundation, Hypertension Trust, Queen Elizabeth II Health Sciences Centre Research Fund, Reichstadt family, and The Stroke Association (through its funding of the Division of Stroke, University of Nottingham). ENOS acknowledges the support of the UK NIHR, through the Stroke Research Network. Finally, we thank the members of the independent data monitoring committee who supervised safety from the beginning to the end of the trial.

Published
2014
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