Moderator of 1 Session
Presenter of 8 Presentations
Panel Discussion & Closing Remarks
Opening by Chairs
Long-term protection: key priorities in antithrombotic treatment after ischaemic stroke/TIA
Neurosonology in Stroke Critical Care
Closing by Chairs
PREVALENCE, TRAJECTORY AND PREDICTORS OF POST STROKE PAIN
Abstract
Background and Aims
Post-stroke pain remains under-diagnosed and inadequately managed. To inform screening and intervention development, we examined prevalence, trajectory and predictors of post-stroke pain.
Methods
Analyses of the Virtual International Stroke Trials Archives (VISTA) examined demography, available pain assessments, mobility, independence, language-impairments, stroke-severities and medical histories. Pain assessments were transformed to match the range of the European Quality of Life Scale [EQ-5D-3L] pain-domain (no/moderate/extreme pain). We described pain prevalence, characteristics of participants reporting extreme versus no/moderate pain, and associations between participant characteristics and pain using multivariable models.
Results
Participants’ (n=10,002) median age was 70.0 years (IQR [59.0,77.1]), 5,560 (55.6%) were male, stroke-severity was NIHSS 10 (IQR [7,15]) and 2,269/6,066 (37.4%) had language-impairment. Extreme pain was reported in 4/132 (3%) at 0-4 weeks, 274/5,094 (5.4%) between 5weeks-3months, 81/865 (9.4%) between 4-6months, 292/4,776 (6.1%) between 6-12 months, 53/773 (6.9%) between 1-2years and 31/328 (9.5%) beyond 2 years post-stroke. Beyond 5 weeks, people reporting extreme pain had poorer independence compared to those reporting no/moderate pain. Adjusting for age, sex, stroke-severity, mobility, diabetes, and language-impairment, poorer independence was significantly associated with presence (5weeks-3months p<0.001, OR=1.5, 95%CI [1.4, 1.6]; 4-6months p<0.001, OR=1.7 95%CI [1.3, 2.1]; >6months p=0.001, OR=1.5, 95%CI [1.2, 2.0]) and amount of pain (5weeks-3months: p<0.001, OR=1.2, 95%CI [1.1,1.2]; 4-6months p<0.001; OR=1.1; 95%CI [1.1, 1.2]; >6months p<0.001, OR=1.2, 95%CI [1.1, 1.2]).
Conclusions
Beyond 4-6 months post-stroke, 6-10% of people report extreme pain that is associated with poorer independence. Future investigation could determine whether and when interventions may reduce the frequency or severity of post-stroke pain.
HOW WELL DOES ASSESSMENT OF PAIN USING MULTI-DOMAIN ASSESSMENT TOOLS REFLECT PAIN, ACTIVITIES OF DAILY LIVING AND INDEPENDENCE
Abstract
Background and Aims
Post-stroke pain is assessed using a range of measures. We described how well pain reported in multidomain assessments reflected pain and associated impacts on activities of daily living and independence.
Methods
Analyses of anonymised data from the Virtual International Stroke Trials Archive (VISTA) described Pearson Correlations examining (i) direct comparisons of pain scales, (ii) indirect comparisons of pain scales through strengths of association with the Barthel Index (BI) and modified Rankin Scale (mRS), and (iii) whether capture of pain could be enhanced by accounting for usual activities, self-care, mobility and anxiety/depression; factors associated with pain.
Results
Pain assessment data using the European Quality of Life 3 and 5 Level (EQ-5D-3L and EQ5D-5L), RAND 36 Item Health Survey 1.0 (SF-36) or the 0-10 Numeric Pain Rating Scale (NPRS) were available for 10,002 people. The Pearson correlation between the EQ-5D-3L, EQ5D-5L and the NPRS was R=0.572 (n=436), and R=0.305 (n=1134), respectively. mRS correlated better with pain by EQ-5D-3L (n=8966; R=0.340) than by SF-36 (n=623; R=0.318). BI correlated best with pain by SF-36 (n=623; R=0.320). Adjusting for age, sex, EQ-5D mobility, usual-activities, self-care, and anxiety/depression scores increased the correlation between the NPRS and EQ-5D 3L and 5L pain scores (R=0.572 to R=0.600 [5%] and R=0.305 to R=0.440 [44%], respectively). Creating a composite score including pain, mobility, usual-activities, self-care and anxiety/depression on EQ-5D-3L and 5L did not improve correlation with the NPRS.
Conclusions
The EQ-5D-3L offers moderate pain capture; this was not enhanced by creating a composite score including pain, mobility, anxiety/depression, usual activities and self-care.
REAL-WORLD EFFECTIVENESS ON THE USE OF MLC601/MLC901: PERIODIC ANALYSIS OF NEUROAID SAFETY TREATMENT (NEST) REGISTRY
Abstract
Background and Aims
NeuroAiD (MLC601 and MLC 901) is a combination of natural products shown to have neuroprotective and neuroproliferative properties which were elucidated in various preclinical and clinical studies. NeuroAID Safe Treatment Registry (NeST) aims to assess the use and safety of NeuroAiD in real world settings.
Methods
Patients taking or prescribed NeuroAiD and have agreed to participate were included in the study. Clinical data were prospectively entered through an online system and collected at baseline and month 1 to 3. Outcome measures included National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS), modified Rankin Scale (mRS) and Short Orientation Memory-Concentration Test (SOMCT). Primary Outcome included safety through the reporting of adverse events, while compliance and neurological status are the secondary outcome measures.
Results
A total of 735 patients were enrolled. Mean age was 58.9±15.4yr,58% were male. Comorbidities included hypertension (70 %), diabetes (23%), hyperlipidaemia (33%), cardiac disease (16%), and smoking (13%). Stroke accounts for 69%, intracerebral haemorrhage 15%, traumatic brain injury 7.6%. 60 -80 % were compliant. At month 3, the mean NIHSS is 5 (± 5.47), the mean mRS 1.9 ±1.5 with greater proportions of patient achieving improvement in mean score from baseline. The SOMCT however, showed decline from baseline to month 3.
Conclusions
Real world data showed MLC601/MLC901 is safe and has therapeutic potential, with good compliance.