Artículos de revistas
Head Position in Stroke Trial (HeadPoST) - sitting-up vs lying-flat positioning of patients with acute stroke: study protocol for a cluster randomised controlled trial
Fecha
2015Registro en:
Trials (2015) 16:256
DOI 10.1186/s13063-015-0767-1
Autor
Muñoz Venturelli, Paula
Arima, Hisatomi
Lavados Germain, Pablo Manuel
Brunser, Alejandro
Peng, Bin
Cui, Liying
Song, Lily
Billot, Laurent
Boaden, Elizabeth
Hackett, Maree L.
Heritier, Stephane
Jan, Stephen
Middleton, Sandy
Olavarría, Verónica V.
Lim, Joyce Y.
Lindley, Richard I.
Heeley, Emma
Robinson, Thompson
Pontes Neto, Octavio
Natsagdorj, Lkhamtsoo
Lin, Ruey-Tay
Watkins, Caroline
Anderson, Craig S.
Institución
Resumen
Background: Positioning a patient lying-flat in the acute phase of ischaemic stroke may improve recovery and reduce disability, but such a possibility has not been formally tested in a randomised trial. We therefore initiated the Head Position in Stroke Trial (HeadPoST) to determine the effects of lying-flat (0 degrees) compared with sitting-up (>= 30 degrees) head positioning in the first 24 hours of hospital admission for patients with acute stroke.
Methods/Design: We plan to conduct an international, cluster randomised, crossover, open, blinded outcome-assessed clinical trial involving 140 study hospitals (clusters) with established acute stroke care programs. Each hospital will be randomly assigned to sequential policies of lying-flat (0 degrees) or sitting- up (>= 30 degrees) head position as a 'business as usual' stroke care policy during the first 24 hours of admittance. Each hospital is required to recruit 60 consecutive patients with acute ischaemic stroke (AIS), and all patients with acute intracerebral haemorrhage (ICH) (an estimated average of 10), in the first randomised head position policy before crossing over to the second head position policy with a similar recruitment target. After collection of in-hospital clinical and management data and 7-day outcomes, central trained blinded assessors will conduct a telephone disability assessment with the modified Rankin Scale at 90 days. The primary outcome for analysis is a shift (defined as improvement) in death or disability on this scale. For a cluster size of 60 patients with AIS per intervention and with various assumptions including an intracluster correlation coefficient of 0.03, a sample size of 16,800 patients at 140 centres will provide 90 % power (alpha 0.05) to detect at least a 16 % relative improvement (shift) in an ordinal logistic regression analysis of the primary outcome. The treatment effect will also be assessed in all patients with ICH who are recruited during each treatment study period.
Discussion: HeadPoST is a large international clinical trial in which we will rigorously evaluate the effects of different head positioning in patients with acute stroke.