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Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke
Craig S Anderson1, Hisatomi Arima1, Pablo Lavados1
1From the George Institute for Global Health (C.S.A., H.A., L.B., M.L.H., P.M.V., K.R., J.Y.L., M.W.) and Faculty of Medicine (C.S.A., L.B., M.L.H., L.S., K.R., J.Y.L., M.W.), University of New South Wales, the Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners (C.S.A.), the Nursing Research Institute, St. Vincent's Health (S.M.), and Australian Catholic University (S.M., C.W.) - all in Sydney; the George Institute China at Peking University Health Science Center (C.S.A., L.S.) and the Department of Neurology, Peking Union Medical College Hospital (B.P., L.C.) Beijing, and the Department of Neurology, 85 Hospital of People's Liberation Army, Shanghai (L.S.) - all in China; the Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); the Department of Neurology and Psychiatry, Clínica Alemana de Santiago (P.L., V.V.O., P.M.V., A.B.), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo (P.L.), and Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile (P.L.) - all in Santiago, Chile; the College of Health and Wellbeing, University of Central Lancashire, Preston (M.L.H., D.F., C.E.L., C.W.), the George Institute for Global Health, University of Oxford (M.W.), the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh (G.E.M.), and the Department of Cardiovascular Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester (T.R.) - all in the United Kingdom; the Department of Epidemiology, Johns Hopkins University, Baltimore (M.W.); the Stroke Service-Neurology Division, Department of Neuroscience and Behavior, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo (O.P.-N.); the Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka (H.A.D.S.); the Department of Neurology, Christian Medical College, Ludhiana, India (J.D.P.); and the Department of Neurology, Kaohsiung Medical University and Hospital, Kaohsiung (R.-T.L.), and the Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan (T.-H.L.) - both in Taiwan.
Lying flat after acute stroke did not improve patient outcomes compared to sitting up. This study found no significant differences in disability or mortality between the two head positioning methods for stroke patients.
Area of Science:
- Neurology
- Clinical Trials
- Public Health
Background:
- Clinical practice varies regarding head positioning for acute stroke patients due to conflicting factors like cerebral blood flow and aspiration risk.
- Investigating optimal patient positioning is crucial for improving acute ischemic stroke outcomes.
Purpose of the Study:
- To determine if a lying-flat position improves outcomes for acute ischemic stroke patients compared to a sitting-up position.
- To assess the impact of head positioning on cerebral perfusion and patient disability.
Main Methods:
- A pragmatic, cluster-randomized, crossover trial involving 11,093 acute stroke patients across nine countries.
- Patients were assigned to either a lying-flat or a sitting-up (head elevated ≥30 degrees) position for 24 hours post-admission.
- The primary outcome was degree of disability at 90 days, measured by the modified Rankin scale.
Main Results:
- No significant difference in 90-day disability outcomes on the modified Rankin scale between the lying-flat and sitting-up groups.
- Mortality at 90 days was similar: 7.3% in the lying-flat group vs. 7.4% in the sitting-up group.
- No significant differences in serious adverse events, including pneumonia, were observed between groups.
Conclusions:
- Head positioning (lying flat vs. sitting up) for 24 hours did not significantly alter disability outcomes after acute stroke.
- The findings suggest that current variations in head positioning practices for acute stroke may not impact patient recovery.
- Further research may be needed to explore other factors influencing stroke recovery and patient positioning.
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