The UK Stroke Forum 2023 (UKSF 23), the UK’s largest multidisciplinary Stroke conference, was held at the International Convention Centre (ICC), Birmingham from 4-6th December 2023 and was attended by over 1800 stroke professionals.
2023 was dubbed ‘Year of the Guideline’ with updates to both the National Clinical Guideline for Stroke (NCG 23) and NICE stroke rehabilitation guideline (NG236) published during the year. The conference opened with a rousing, interactive introduction from ‘Singing Medicine’ demonstrating the valuable contribution singing can make to stroke rehabilitation. This was followed by the opening plenary ‘Reducing Health Equity in Stroke’. Dr Matt Kearney discussed the importance of a preventative approach to cardiovascular disease (CVD). Data has shown over 16,000 heart attacks and strokes would be prevented in 3 years if optimisation rates were increased to 80%. However, optimisation rates have not yet reached pre-pandemic levels, leaving thousands of patients at risk of CVD. Delegates were introduced to CVD ACTION, a smart data tool developed by UCL Partners to support targeted action on areas of health inequality. CVD ACTION enables GP practices and primary care networks to adopt a holistic approach to preventative care by addressing multiple conditions in an individual patient.
The topic of health inequity continued with Juliet Bouverie OBE interviewing Mrs Ann Bamford and Mr Charles Kwaku-Odoi. Ann Bamford emphasised the importance of finding ways to hear the voices of those who are often under-represented in research. Mr Kwaku-Odoi affirmed that research has been highlighting inequalities for many years, however system change was needed to enable voices of ethnic minority groups to be heard.
The conference then divided into several parallel sessions. ‘Neuropsychological support after stroke’ was a valuable session which emphasised the importance of personalised, holistic care. An account of a stroke survivor’s lived experience highlighted that there is no such thing as a minor stroke from a psychological point of view. Case studies were presented which affirmed the value of including specialist neuropsychological support across the stroke pathway, as recommended in NCG 23. Issues such as post stroke apathy, impaired executive function and low mood all have a huge impact on quality of life and ability to engage with rehabilitation. Neuropsychological support enables stroke survivors and their families to create strategies, adjust and re-build in order to work towards building a ‘new me’.
Day one concluded with a bonus plenary – ‘The changing face of stroke – Implementing the new guidelines into practice’. Louise Clark presented updates in therapy delivery, with NCG 23 recommending a minimum of 3 hours multidisciplinary therapy a day for those with motor recovery goals. This is leading clinicians to think creatively about how services need to be developed to meet this target. Virtual therapy was discussed as well as group work, open gyms to encourage self-directed or carer directed activity, and working with ‘rehab partners’ to work towards a goal of 6 hours of activity a day.
Day 2 began with a choice of workshops providing perfect opportunities for networking and sharing innovative new ideas, as well as encouraging each other to strive towards improvements in stroke care. Further parallel sessions followed including ‘Recent updates in thrombectomy, and their application in daily practice’. Updates on the latest research were discussed, alongside the challenge to deliver thrombolysis to a wider range of patients including those with low NIHSS, low ASPECT and large core, as recommended in NCG 23. Dr Soma Banerjee highlighted the importance of deciding imaging protocols for large core thrombectomy, and affirmed that low NIHSS thrombectomy does not yet have adequate evidence base. Professor Keith Muir discussed updates from the ATTEST-2 trial which strengthens recommendations in favour of Tenecteplase as the standard of care for IV thrombolysis. Professor Christine Roffe compared data from several recent multi-centre RCTs of Endovascular therapy for basillar artery occlusion (BAO) compared to best medical treatment (BASICS 2021, BEST 2019, ATTENTION 2022, BAOCHE 2022). She concluded that despite uncertainties in how best to score ischaemia, the type of anaesthesia and the time limit for thrombolysis, thrombectomy is effective in basillar occlusion. Dr Roffe also highlighted the importance of including brain stem aetiology in differential diagnosis of coma, as subtleties in presentation can often lead to delays in diagnosis of BAO.
Later, the annual Princess Margaret Memorial lecture entitled ‘A vision for vision’ was delivered by Professor Fiona Rowe. The importance of early visual assessment was emphasised, as recent research has shown 40% of stroke survivors do not or cannot report visual symptoms. However, there is currently a vision service available in only 50% of UK stroke units. This is despite NCG 23 recommending orthoptists should be part of the core stroke team, and patients should have an orthoptist review before discharge, or urgent out-patient review. Professor Rowe also highlighted the V-FAST screening tool, including any new visual problems in the already well-known FAST assessment. This is being developed as a joint project with North-West Ambulance service.
Day 3 began with further parallel sessions including ‘Integrated, personalised stroke care’. Mrs Harriett Allen discussed the role of the stroke specialist social worker and how incorporating the role led to improvements in patient and staff experience. Dr Beth Clark highlighted the NHS personalised care operating model which encourages proactive, personalised conversations to develop and agree a plan of care. This ultimately leads to each person having a shareable plan of care which records what matters to them and how they will achieve their outcomes.
This was followed by workshops including ‘Cognitive communication disorder (CCD) after stroke’. A case study was presented showing the impact of CCD on quality of life including changes in relationships and inability to return to work. The complexities of CCD were discussed, and the need for further research into the presence of CCD in stroke, as there are currently no UK studies.
The closing plenary ‘Game changers and their implications for stroke policy, research and practice’ presented areas of stroke research which will make an impact over several years, encourage innovative thought, and challenge the way stroke care is currently delivered.
The UK Stroke Forum 2023 was a fantastic opportunity to be immersed in innovations in stroke care. The updated guidelines present real challenges for stroke services, however the many dedicated teams across the UK remain determined to optimise stroke prevention, and to strive towards improved outcomes for survivors across the stroke pathway.
Updated Guidelines 2023:
National Clinical Guideline for Stroke for the UK and Ireland. London: Intercollegiate Stroke Working Party; 2023 May 4. Available at: www.strokeguideline.org.
NICE stroke rehabilitation guideline (NG236). Available at: www.nice.org.uk/guidance/ng236
Speakers included in report:
Mrs Harriett Allen – Clinical Lead for Community stroke and Neuro team- Manchester Foundation Trust
Mrs Ann Bamford – Honorary PPE lead of the Geoffrey Jefferson Brain research centre (University of Manchester)
Dr Soma Banerjee – Head of speciality and Consultant in stroke medicine – Imperial College Healthcare.
Juliet Bouverie OBE – Chief Executive of Stroke Association
Dr Beth Clark – Personalised care facilitator – Wessex academy for skills in personalised care.
Louise Clark – Stroke Consultant therapist and SSNAP associate director
Dr Matt Kearney – Executive clinical director for cardiovascular health – UCL Partners.
Mr Charles Kwaku-Odoi – Chief Executive of the Caribbean and African health network.
Dr Matt Lambert Consultant in Stroke and Medicine for the Elderly, Clinical lead for stroke – NHS Tayside.
Professor Keith Muir – Professor of Clinical Imaging and Consultant Neurologist – University of Glasgow
Professor Christine Roffe – Professor of Stroke Medicine – Keele University.
Professor Fiona Rowe – Professor of Orthoptics at University of Liverpool
