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Lying flat after stroke 'no more beneficial' than sitting up

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Lying patients flat on their backs soon after the onset of a severe stroke does not appear to affect outcomes despite suggestions that it could improve recovery by aiding blood flow to the brain, according to a major new study spanning nine countries.

The study, published in the New England Journal of Medicine, set out to explore whether lying patients flat after an acute stroke made a difference to survival rates and other outcomes, compared to sitting them up.

“Any modification of cerebral blood flow that may have occurred as a result of head positioning initiated within 24 hours was insufficient to reduce the neurologic deficit”

International study on stroke recovery

A form of randomised controlled trial was carried out involving more than 11,000 stroke patients in nine different countries, including the UK, Australia, China, and parts of South America.

Depending on the hospital they were admitted to, patients either received care in a lying flat position or sitting up with their head elevated to at least 30 degrees.

The different positions were initiated soon after patients were admitted to hospital – 14 hours on average after the onset of a stroke - and then maintained for 24 hours.

Results were assessed 90 days later using a disability score from 0 to 6.

The international team of researchers who carried out the study, which was funded with a research grant from the National Health and Medical Research Council of Australia, found little difference in the distribution of scores for each group.

”The lying-flat head position, as compared to the sitting-up position… did not alter disability outcomes in patients with acute stroke”

International study on stroke recovery

The death rate within 90 days was 7.3% among the patients in the lying-flat group and 7.4% among those in the sitting-up group.

Meanwhile there was no significant difference between the two groups when it came to rates of “serious adverse events” such as contracting pneumonia.

The researchers said their findings show there was “no significant difference” between the two approaches or any clear evidence that lying flat reduced the effects of stroke.

“The negative results of this trial suggest that any modification of cerebral blood flow that may have occurred as a result of head positioning initiated within 24 hours was insufficient to reduce the neurologic deficit associated with acute stroke,” said the paper, called Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke.

“In conclusion, the lying-flat head position, as compared to the sitting-up position, initiated early after presentation and maintained for 24 hours, did not alter disability outcomes in patients with acute stroke,” it concluded.

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