Stroke Clinical Trial
Official title:
A Non-interventional Observational Study to Document the Clinical Course of Patients Following Ischaemic Stroke and to Establish a Pool of Patients for Future Trials in the Ischaemic Stroke Setting
The rationale for this study is to facilitate future Phase II/III clinical trials and improve outcome for patients suffering residual disability after an ischaemic stroke. Main study objectives are to document and better define the prognostic characteristics of residual disability in patients following an ischaemic stroke, to inform the design of small efficient Phase II studies when screening potentially efficacious interventions for signals of activity which merit further development and to establish a pool of patients who may be approached to participate in future clinical trials in the ischaemic stroke setting.
Experience of conducting a Phase I study of an advanced medicinal therapy for ischaemic
stroke and planning a Phase II efficacy study for this indication has revealed a number of
opportunities to facilitate future clinical trials for this important indication.
Two key issues were identified which could be easily addressed with forward planning of
future trials in the ischaemic clinical setting:
- The population readily available for clinical trials of potentially useful new agents
is limited, as many patients presenting with a stroke are treated in an acute unit but
then may "drop-out" of the acute neurology or academic catchment populations when they
are transferred to a variety of settings for subsequent management, such as long-term
hospital care in a geriatric ward, residential care or home care by relatives with
assistance from social support. Thus, establishing a pool of patients willing to be
contacted about future clinical trials after they leave the acute stroke facility would
facilitate future stroke studies. It would ensure such patients were offered the
opportunity to participate in relevant clinical trials and any additional related care
(e.g. additional physiotherapy).
- Despite a substantial amount of literature on the management of stroke, planning of
Phase II studies is still handicapped by insufficient information to clearly identify
which patients will be left with residual disability and the time-course of any
improvement with current standards of care. Optimal populations and clinical trial
methodology for screening potential new interventions for stroke have not been
established. Building a robust dataset to better identify such populations would: 1)
improve the speed and reduce the cost of screening candidates, 2) permit use of more
efficient statistical methods to screen for activity, and 3) increase the opportunity
to identify new treatments for post stroke disability.
A core dataset will be recorded including the patient's National Health Service number, age,
gender and stroke outcome measured by four standard validated rating scales; Action Research
Arm Test (ARAT), National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale
(mRS) and Barthel Index (BI). All patients consenting to participate in the program would
also consent to being contacted to determine their interest in participating in future
regulated clinical trials of interventions for patients with a history of ischaemic stroke.
The consent form for this study would make it clear that the patient is under no obligation
to participate in any other study.
In addition to the core dataset, participating centres may elect to add additional
sub-protocols to this study to collect additional non-core data: for example, assessment of
cognitive or visual function, mood, fatigue or other measures of performance, structural or
functional MRI imaging or other investigations related to the patient's progress following
the presenting stroke. Additional assessment criteria outside the core dataset of this study
would be the subject of centre-specific sub-protocols and must be approved as required by
national and local requirements.
Co-recruitment of patients into other studies is allowable, if permitted within the other
study protocol.
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Observational Model: Case-Only, Time Perspective: Prospective
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