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Stroke Causes and Treatment: Patient's Head Positioning May Not Affect Outcome After Stroke

A photo of a stroke patient undergoing an electrocardiogram (ECG) test at Juntendo University Hospital in Tokyo.
A photo of a stroke patient undergoing an electrocardiogram (ECG) test at Juntendo University Hospital in Tokyo. |

It was determined in a recent study that the head position of a patient during treatment for acute stroke would not affect disability outcomes, dispelling a widely accepted belief held by various doctors in the field.

It is believed that lying flat on one's back could improve recovery of stroke patients by increasing blood flow in the brain's main arteries. However, no existing clinical evidence currently supports this belief, and now, a study published this month in The New England Journal of Medicine (NEJM) revealed that there is no significant difference in the disability outcomes of patients depending on their head positions.

This determination was achieved after conducting a 21-month trial from March 2015 until November 2016, which involved the examination of the clinical outcomes of 11,093 brain stroke patients from 114 hospitals in nine different countries. The study investigated patients who were assigned varying head positions during treatment.

"The head positions — lying flat or an incline position with support behind the back — don't affect the treatment outcome," Jerayaj D. Pandian, the head of neurology at Christian Medical College in Ludhiana, India, told Deccan Herald.

For the study, some stroke patients were told to lie flat on their back while others had their heads raised to the minimum inclination of 30 degrees in the first 24 hours after they were admitted to the hospital. These patients were then assessed after 90 days.

After this 90-day period, researchers determined there were no significant differences in the death rates and the disabilities between the two groups of the study.

"We showed that the variations don't matter. We found is that patients who were lying flat, felt somewhat uncomfortable, but it certainly didn't make their condition any worse. Our findings suggest a review of current clinical practice guidelines is warranted," Pandian explained.

The findings could be relieving news for some stroke patients who feel worried when they are not lying on their back during their period of recovery.

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