Why is this research needed?
Frailty - finding it difficult to 'bounce back' from illness or injury - is very common among people who have a stroke.
Dr Matt O’Connell, lead researcher on this project, says, “Recent research has shown that frailer people are more likely to have a stroke and to have more difficulty recovering afterwards. What we don’t know is whether the effect of frailty is similar in patients of different age, or gender, or those with other diagnoses before their stroke. At the moment, it is also difficult to use information on frailty to help doctors make the best decisions for treating each patient.”
There are lots of questions we need answers to in the area of stroke and frailty:
- How should we measure frailty when someone's had a stroke? Standard frailty measures may not be suitable for stroke patients, for example because they involve physical tests that may not be possible for someone who’s recently had a stroke.
- How does frailty interact with other long term conditions and what does that mean for stroke care? More than 9 in 10 stroke patients have at least one other health condition so we need to be able to take these into account.
- How does frailty interact with characteristics like age, sex and ethnicity? All of these can affect your likelihood of having a stroke and how you're likely to respond to treatment.
Because we don't have answers to the questions above, we also don't know the answer to the most important question of all: how should we use information about frailty when deciding how to treat strokes and support stroke survivors with rehabilitation?
What are the aims of this research?
Matt and the team aim to create two new tools that could improve how we manage stroke treatment, rehabilitation and long-term care: a stroke frailty score and a future health needs score.
The team will use two databases of healthcare information: the South London Stroke Register (SLSR) and the Clinical Practice Research Datalink (CPRD).
First, using information from the SLSR, they’ll develop and test a stroke frailty score, looking at how well if compares to a general frailty score called the eFI.
Next, using the eFI and the stroke frailty score they’ve just developed, they’ll explore how frailty affects short- and long-term health in stroke survivors. They’ll look at the effects of frailty overall to start with, then dive deeper to understand whether the effects of frailty look different for different groups of stroke survivors.
They’ll bring together all the work from earlier stages of the project to develop a score that predicts the future health needs of a stroke survivor.
They’ll also hold focus groups and interviews with people affected by stroke and healthcare professionals to understand what they think of the stroke frailty score and future health needs score and what support they’d like to understand and use them.
What is the benefit of this research?
Matt and the team plan to make the new stroke frailty score and future health needs score compatible with existing healthcare record systems. They also want to make them freely available to other healthcare professionals and researchers.
Matt says, “I hope this research will help allow doctors to tailor their treatments to give the best results for each patient. I also hope we will be able to help people affected by stroke to better understand their future health risks and the treatment they receive.”
What PSP priorities does this research link to?
From 2019 to 2021, we worked with the James Lind Alliance on the Stroke Priority Setting Partnership (PSP). During the PSP process, we collaborated with people with lived experience of stroke and stroke professionals to find out what they thought were the top priorities in stroke research. From this, we identified the top ten priorities in two areas: prevention, diagnosis and short-term care, and rehabilitation and long-term care.
Now, when researchers apply to us for funding, we require that their work addresses at least one of these priorities, or a priority from the Childhood Neurological Disabilities PSP Top 10 as it relates to childhood stroke.
This project addresses the following priorities from the Stroke PSP:
- Prevention and acute care 10: Effects of other health conditions and characteristics
- Rehab and long term care 1: Mental and emotional difficulties after stroke
- Rehab and long term care 2: Thinking and memory difficulties after stroke
- Rehab and long term care 6: Impacts of stroke on everyday life
Meet the team
This project is led by Dr Matt O’Connell, Senior Lecturer in Population Health Sciences at King’s College London. Matt is an expert in stroke and frailty.
Matt says, “I’m looking forward to using the SLSR and the CPRD to understand how frailty affects different people with stroke. The project will help us to understand the potential of national health record data for further stroke research. I’m also looking forward to collaborating with people affected by stroke to learn how to use the results of the research to affect stroke care in the most meaningful way.”
The other members of the team include:
- Dr David Wyatt, Senior Research Fellow in Social Science at King’s College London. David leads on the interviews, focus groups and patient and public involvement aspects of the project.
- Abdel Douiri, Professor of Medical Statistics and Clinical Trials at King’s College London. Abdel leads on the statistical analyses for the project.
- Dr Emma Rezel-Potts, Research Associate in Translational Epidemiology and Public Health at King’s College London. Emma is an epidemiologist and will support in analysing data from the CPRD.
- Dr Iain Marshall, Clinical Senior Lecturer in Population Health Sciences at King’s College London. Iain leads the stroke research programme at King’s College London and will provide clinical insight from his work as a GP.
- Dr Ajay Bhalla, Consultant Physician in Stroke, Geriatric Medicine and General Medicine at Guy's And St Thomas' NHS Foundation Trust. Ajay will provide clinical insight from his work in stroke treatment and care.
- Charles Wolfe, Professor Emeritus in Public Health at King’s College London. Charles was formerly the lead investigator of the SLSR and the stroke research programme at King’s College London. He will provide expertise in public health and stroke research, as well as acting as a mentor to the rest of the team.
- Dr Martin Chapman, Lecturer in Health Informatics at King’s College London. Martin is an expert in developing digital health tools like the calculators that will be created in this project.
The team will also be joined by a research assistant who will run the focus groups and interviews and a research associate who will analyse the data gathered during these.