Background- Stroke rehabilitation involves a multidisciplinary team providing comprehensive care to the patient.(1) The functioning of Stroke Units (SU), the highest evidence available for stroke care, is guided by the World Stroke Organisations (WSO) roadmap of core recommendations and key quality indicators.(2) Objectives- To evaluate the quality of stroke rehabilitationin comparison to the WSO core recommendations at a tertiary care centre in India Methodology-A mixed method design with an exploratory research model was used. The study was conducted in 2 phases including retrospective data extraction from medical records and telephonic follow-up on the patients functional status and adherence to physiotherapy post-discharge. 84 patient records (those admitted between Jan –June 2021) were screened. Data was extracted from 49 patient files that fulfilled inclusion criteria. 35 patients were excluded due to unavailability of patient files, non-stroke related hospital admissions. In Phase 2, qualitative data was gathered using telephonic interviews, from 7 patients who consented for the same. Results- The mean age of the sample was 56.9 ±13years with approximately two third being males and a predominance towards ischaemic strokes (62%). Those with severe impairment on Fugl Meyer assessment were 28% of the sample. It was observed that there was inconsistent documentation of various core recommendations provided by WSO (<20%) while 16% of the services provided were not documented at all. Only two of the five key quality indicators of stroke rehab were documented.

Background: We aim to assess the role of quantitative electroencephalography (QEEG) derived indices to predict post-stroke disability. Methods: We included observational studies (sample-size≥10) of patients with stroke who underwent EEG and a follow-up outcome assessment was available either in form of a modified Rankin scale (mRS) or National Institute of stroke scale (NIHSS) or Fugl-Meyer scale (FMA). QEEG indices analyzed were delta-alpha ratio (DAR), delta-theta-alpha-beta ratio (DTABR), brain symmetry (BSI) and pairwise derived brain symmetry (pdBSI). Results: Twelve studies (11 had only ischemic stroke, and one had both ischemic and hemorrhagic stroke), including 513 participants were included for meta-analysis. Higher DAR was associated with worse mRS (n=300, Pearson’s r 0.26, 95% CI 0.21-0.31). Higher DTABR was associated with worse mRS (n=337, r 0.32, 95% CI 0.26-0.39). Higher DAR was associated with higher NIHSS (n=161, r 0.42, 95% CI0.24-0.6). Higher DTABR was associated with higher NIHSS (n=172, r 0.49, 95% CI 0.31-0.67). pdBSI was inversely associated with FMA (n=20, r-0.50 95% CI -0.86-(-0.14)) and BSI was not associated with FMA (n=21, r -0.3 95% CI -0.81-0.22). Conclusions: QEEG-derived indices have the potential to assess post-stroke disability. Adding QEEG to the clinical and imaging biomarkers may help in better prediction of post-stroke recovery.PROSPERO 2022 CRD42022292281

Introduction: Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in INDIA Trial delivered secondary stroke awareness intervention to sub-acute stroke patients in form of workbook, videos and SMS across 31 centres in 12 languages. Trial was stopped for futility due to fewer vascular outcomes than anticipated. Trial results indicated that trial intervention, did not lead to reduction in vascular events. We carried out process evaluation, to evaluate trial implementation and participant’s perspectives, to comprehend the trial’s futile outcomes. Materials and Methods: Using mixed methods approach, qualitative interviews and quantitative data from case report forms, workbooks and questionnaires were analysed to measure intervention fidelity and contamination. Using purposive sampling, 115 interviews of patient-caregiver dyads and health professionals at 11 centres and 2 focus group discussions were held. Results and discussion: Iterative thematic analysis of qualitative data was done with RE-AIM and realist models. There was good fidelity to intervention and adherence to protocol; however, there was dilution of inclusion criteria by randomly enrolling uneducated and caregiver-dependent patients. Centre coordinators provided counselling to both arms, not specified by protocol, causing bias. Coordinators found it difficult to keep patients motivated to view intervention which was corroborated by fidelity questionnaire showing decreased viewing of intervention for a year. Cardiovascular protection improved in routine care by virtue of participating in trial. No contamination of intervention was reported. Conclusion: The intervention was acceptable by patients and caregivers, which could be made a community-based programme. Reasons identified for decreased viewing were repetitive content and non-availability of personal cellular device.