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THE STROKE OUTCOMES STUDIES: SOS2 & SOS3
Background
In 2001, the Academic Unit of Psychiatry and Behavioural
Sciences at Leeds University successfully bid for funds to
conduct two substantial projects which started in March 2002.. The first of these, from
the Stroke Association, is supporting a study of the effect
of early depression on outcomes for stroke patients (SOS2)
and the second, from the NHS Service Delivery and Organisation
(SDO) Research and Development Programme, is funding research
into the effects of continuity of care on outcomes after stroke
(SOS3).
As the two studies were being planned it became clear that combining the prospective cohort phases of the studies would reduce the burden on patients and allow more time- and cost-effective data collection. Both studies shared the same outcome measures and a joint approach would enable additional follow-up of the study patients at time points when they might have experienced changes in their care or circumstances. Thus it would be possible to obtain a more complete picture of the way in which outcomes may change over time for individual patients. The SOS research portfolio therefore encompasses a series of interlinked projects, each with its own aims and objectives but sharing assessments and data collection where appropriate.
SOS2: Depression in the
first weeks after stroke: its association with outcomes and
its response to antidepressant medication.
Depression has been claimed to have important effects on longer-term
outcomes for patients with stroke and particularly on how
patients fare in the immediate time after discharge from hospital.
This link is perhaps not unexpected as quality of life, most
often used to measure this type of outcome, has a large emotional
component. However, there are still gaps in our understanding
of the effect of depression in stroke patients, especially
in the early stages. Evidence to date has been obtained from
a number of small studies in which important factors such
as the severity of the stroke and the other physical illnesses
of the participants have not always been fully considered.
The SOS programme aims to recruit and follow-up 900 patients over 3 years from both the Leeds and Bradford hospitals. Patients will be recruited consecutively after their initial or recurrent episode of stroke and, although some patients will obviously be excluded if they are too poorly or unable to give consent, we hope to include as many people as possible thereby studying a representative sample. Measures of mood, cognitive function and physical status will be used as the principle outcome measures for the study.
Alongside the question of the effect of depression is the lack of clarity on the real benefits of treatment for depression and its possible disadvantages, particularly in an elderly population. For this reason, a randomized controlled trial of anti-depressant medication will also form part of the main study in order to investigate its effect compared to a placebo (dummy drug) on early depression.
SOS3 Continuity of Care
in Stroke and its Relation to Outcomes
A survey last year by the Stroke Association revealed huge
variations in stroke care throughout the country. Notwithstanding
the potential bias caused by the poor response rate to this
survey it still raises questions about the provision of services
for stroke patients in the United Kingdom. As part of the
National Service Framework for Older People the Department
of Health is committed to improving the quality of services
and has emphasised the importance of continuity of care by
highlighting it as an area for researchSOS 3 will take this
research forward in the area of stroke: firstly by developing
two simple measures of continuity of care, one using an interview-based
study of a group of patients who will be selected to try and
cover a range of experience, and the other from a review of
their casenotes. Secondly, by applying these measures to the
patients in the cohort study already in place for SOS 2, we
will assess the effect of continuity of care on outcomes.
At the same time SOS 3 will enquire into the meanings of continuity
of care for patients and their carers, and will extend this
further by seeking the views of the professionals involved
in providing stroke care services.
Finally, the study will use the results of the earlier phases to test the feasibility of developing a care package for the first year after stroke. This will specifically address the issue of continuity of care throughout the patient's journey through the health care services.
Stroke is a major disabling disease which causes distress to patients and often places a burden of care on their families. This research will help inform service providers about which aspects of care patients and their carers value most thus enabling them to build a better, more patient-centred service for the future.
If you would like further information about either of the
studies described here please contact one of the
project staff:
Researchers: Secretaries:
Mrs K Hill Mrs J Lower
Miss A Riach Miss C McCarney
Ms J Heaton
at
Academic Unit of Psychiatry and Behavioural Sciences, University
of Leeds, 15 Hyde Terrace, Leeds, LS2 9LT.
Telephone numbers 0113 3432704/3431964.
