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Stroke services

About 250,000 people in the UK live with disability following a stroke at any time.

Around a third of stroke survivors experience communication problems, ranging from lack of clarity of speech through to difficulties comprehending and formulating language.

In an exercise facilitated by the James Lind Alliance, patients and service providers identified 'ways to improve cognition' as their number one research priority to improve life after stroke.

Drs Audrey Bowen and Anne Hesketh, their team at The University of Manchester and other partners recognised unmet service needs for people with cognitive and communication difficulties.

They evaluated the effectiveness and cost effectiveness of speech and language therapy following stroke in their ACT NoW study (Assessing Communication Therapy in the North West). Service users' and carers' views were actively sought, informed the interpretation of the trial evidence and were disseminated.

The team also conducted Cochrane systematic reviews of the evidence for three areas of cognitive rehabilitation.

They showed that the effectiveness of certain promising interventions could not be proved and highlighted changes necessary to produce high quality evidence capable of improving international clinical practice.

The findings and recommendations of the ACT NoW studies (conducted between 2004 and 2010) and systematic reviews had a direct influence on national and international stroke guidelines for the management and rehabilitation of cognition and communication post-stroke, including ending ineffective interventions.

As a result, policymakers across the globe have based recommendations for changes to clinical practice on the evidence provided by the research team's work.

Organisations include the UK's National Institute for Health and Care Excellence, the European Stroke Organization and Australia's National Stroke Foundation.

The team's ongoing trials in communication and cognition continue to have a direct impact on clinical guidelines, rehabilitation and life after stroke in the UK and internationally.

“Over the past decade, University of Manchester led research has provided robust trial and systematic review evidence on which guideline writers have based their recommendations.”

Dr Audrey Bowen / Reader in Psychology