Category: Advancing Modules

What are randomised control trials?

  • Randomised controlled trials (RCT) are a specific type (design) of research study
  • RCTs are used to test whether treatments are effective or not
  • RCTs are used where there is uncertainty about the balance of risks and benefits for a particular treatment.
  • If well designed and executed they provide the most reliable evidence about whether a treatment is effective or not
  • High quality RCTs including large numbers of patients (often 1000s) will provide more reliable evidence than RCTs including smaller numbers
  • RCTs may be used to test the effectiveness of medicines (e.g. aspirin), therapies (e.g. physiotherapy), devices (e.g. anti-embolism stockings), services (e.g. stroke units)

Where do I find research?

Before you start looking for research articles, it is important to remember:

  • Identifying all available research by searching electronic databases can be difficult and time-consuming. You can rarely be certain that you have identified all available research.
  • Research that has been synthesised or summarised in a systematic and rigorous way provides a good way of accessing evidence [See ‘Evidence topic loop’ at bottom of this page].
  • A stroke health professional looking to answer a clinical question should ALWAYS look for summarised evidence first, rather than seeking original research articles.
  • If there are no clear standards, guidelines or summarised evidence THEN it may be appropriate to search for original research articles.

Knowledge Network

  • The Scottish Knowledge Network, provided by NHS Education for Scotland, gives you access to published research.
  • You can enter your search terms on the home page and search for all the research on the Knowledge Network. When you have run your search you will have the option to filter the search results by the type of evidence.
  • The Knowledge Network filters can be extremely useful, and can help you identify evidence such as Best Practice Statements or patient information leaflets.
  • There is a huge volume of evidence on the Knowledge Network. Unless you can make your search quite specific, the quantity of results can be overwhelming. Searching in the Knowledge Network may be beneficial if you are just wanting to increase your knowledge and do some general background reading around a subject.

Cochrane Library

  • The key content on The Cochrane Library is synthesised evidence in the form of systematic reviews.
  • However the Cochrane Library also has a database of clinical trials.
  • If you are looking for high quality evidence in the form of randomised clinical trials The Cochrane Library is an ideal resource.
  • The advantage of the Cochrane Library as compared to Knowledge Network is that the results are limited to systematic reviews and randomised controlled trials.
  • Wiley Online Library

DORIS

  • DORIS is the Database Of Research In Stroke
  • DORIS has been supported by the Scottish Government’s National Advisory Committee for Stroke to give you easy access to high quality stroke evidence.
  • DORIS gives you easy access to guidelines, Cochrane reviews, other systematic reviews and randomised controlled trials.
  • The Cochrane Stroke Group maintain a database of all the stroke trials in the world. These are the trials that are included on DORIS. This is therefore a comprehensive list of high quality stroke research in the form of randomised controlled trials.

Quality of research

Each different research method has important characteristics to help make the results reliable and valid. It is important that research is well planned, designed and executed to answer the question which has been asked.

Research methods

There are a number of different research methods which can be used depending on the type of question being researched.

Research

  • Research can give us the answers to our questions about how to deliver high quality stroke care
  • There are different types of questions we might ask relating to stroke care
  • A good research question will be clearly defined and focussed
  • The most appropriate research method will depend on the nature of the question asked

Links and references

Physical activity quiz

Complete the blanks from the choice of words given to learn more about the link between physical activity and stroke.

So how active am I?

Q. So how active am I?

download the pdf, and enter how much time you spent:

  1. Walking – during the last week did you walk briskly enough to make you feel warm and slightly out of breath for more than 15 minutes at time? (e.g. walk to shops, going out for a walk with friends)
  2. Other activity – within the last week have you done any other activity, for more than 15 minutes at a time, that made you feel warm and slightly out of breath? (e.g. heavy housework, gardening, swimming, dancing, cycling, aerobic classes)

How active am I? [.pdf, 287KB]

  • Less than 150 minutes – you are inactive.
  • 150 minutes or more, but you are active on less than 5 days a week – you need to increase your level of activity.
  • 150 minutes or more, and you are active on more than 5 days a week – that’s good but you need to keep it up.

Sedentary behaviours and barriers to activity

  • Sedentary behaviours complicate the recovery process and affect risk of recurrence. It is a challenge to establish a safe therapeutic exercise regimen to firstly regain previous stroke activity and secondly to reach sufficient activity to reduce stroke risk. Activities should be matched to ability, interests and availability.
  • Find out what is available in your area and be creative!
    • Bums off seats / seated exercise / bowls / golf / dancing / tai chi/ yoga / walking / cycling / gardening
    • Think about types of activity for stamina, strength and flexibility and mobility (see CHSS leaflet )
    • Application of Wii-Fit (Wii-Hab)
  • Barriers to activity:
    • Lack of interest, social support, time, opportunity, transportation, financial means
    • Physical difficulties including paresis, shortness of breath, joint pain
    • Dislike going out alone
    • Perceived lack of fitness
    • Lack of energy
    • Doubting that exercise can lengthen life and lack of knowledge that exercise is beneficial to health
  • There can be many barriers to people participating in activity. Think about using brief interventions to identify what might be suitable. Try to offer alternative types of physical activity.

Physical fitness

Physical fitness – a set of attributes which people have or achieve that confers the ability to perform physical activity

  • Physical fitness is important for the performance of everyday activities. The physical fitness of stroke patients is impaired after their stroke and this may reduce their ability to perform everyday activities and exacerbate any stroke-related disability.
  • In theory physical fitness training after stroke may:
    • Improve function
    • Reduce disability
    • Improve quality of life
    • Improve mood
    • Reduce fatigue
    • Reduce the risk of falls
    • Improve vascular risk factors and so reduce risk of recurrent stroke and death
  • Aim for at least 150 minutes (2 ½ hours) of moderate physical activity a week. For example, 30 minutes on 5 or more days, or a few sessions each day of 10 minutes at a time. Or
    You could do 75 minutes of vigorous activity a week instead. Moderate activity is activity that increases your breathing and heart rate. It makes you feel warm but you are still able to talk. For example, swimming, walking quickly, cycling. Vigorous activity is activity that makes your breathing fast and talking difficult. For example, running, playing sport, hiking uphill. For more information see  CHSS: Physical Activity.