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Anne W Alexandrov1, Georgios Tsivgoulis2, Michael D Hill2

  • 1From the Department of Acute Care, College of Nursing (A.W.A.), and Departments of Neurology (A.W.A., G.T., A.V.A.) and Neurosurgery (A.S.A.), College of Medicine, University of Tennessee Health Science Center at Memphis; Second Department of Neurology (G.T.), National & Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Greece; Department of Clinical Neuroscience (M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurology (D.S.L.), University of California at Los Angeles; Department of Neurology and Neurogeriatrics (P.S.), Johannes Wesling Medical Center, Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Neurology (B.O.), Medical University of South Carolina, Charleston; Semmes Murphy Brain and Spine Institute (A.S.A.), Memphis, TN; Stroke Unit (V.C.), Santa Maria Della Misericordia Hospital, University of Perugia, Italy; Marcus Stroke and Neuroscience Center (R.G.N.), Grady Memorial Hospital, School of Medicine, Emory University, Atlanta, GA; Department of Neurology (J.C.H.), University of California at San Francisco; Memorial Hermann Hospital (J.C.G.), Houston, TX; and Department of Neurology (W.H.), University of Heidelberg, Germany. Anne@outcomesmgmt.org.

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Summary
This summary is machine-generated.

The Head Positioning in Stroke Trial (HeadPoST) had suboptimal methods for evaluating head positioning efficacy in stroke patients. Future trials need refined designs and specific patient cohorts for accurate assessment.

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Area of Science:

  • Neurology
  • Clinical Trials
  • Stroke Rehabilitation

Background:

  • Previous head positioning research informed stroke care strategies.
  • The Head Positioning in Stroke Trial (HeadPoST) aimed to build upon existing knowledge.

Purpose of the Study:

  • To critique the Head Positioning in Stroke Trial (HeadPoST) study methods.
  • To compare HeadPoST findings with prior head positioning research.
  • To clarify the potential efficacy of head positioning interventions in stroke patients.

Main Methods:

  • A systematic review of pre-HeadPoST head positioning studies was conducted by international stroke experts.
  • Methods and findings of prior studies were compared to the HeadPoST trial.
  • Critique focused on patient selection, intervention timing, and outcome assessment.

Main Results:

  • HeadPoST patient selection criteria differed significantly from previous studies, including all stroke types and primarily minor strokes.
  • Late initiation of intervention post-stroke onset and delayed hospital enrollment were noted.
  • Lack of reported intervention integrity and incomplete serial assessments limited the ability to determine intervention effects.

Conclusions:

  • The HeadPoST trial design was suboptimal for evaluating the intervention's efficacy.
  • Future research should focus on discrete patient cohorts, such as large vessel occlusion.
  • Well-powered trials with endpoints supported by pilot data are necessary to establish the efficacy of head positioning.