Abstract
Stroke is the second biggest killer worldwide in people over 60 and disproportionately affects people in resource-poor countries. Research implementation over the past 25 years has successfully led to a number of acute treatments that have dramatically improved survival and outcomes for people with stroke.
High-quality research and consensus in methodological approaches to stroke recovery and rehabilitation research is now more vital than ever, to deliver successful evidence-based interventions that will enable an increasing number of stroke survivors to have a better life after stroke.
We know that many stroke survivors are not getting the post-acute care and support that they need, and a key part of our role to ensure this happens is to fund robust, game-changing research for implementation in healthcare policy and practice to support survivors’ recovery and help them rebuild their lives after stroke. As funders, we have a responsibility to spend our publicly donated funds very carefully, on high-quality research that leads to impact for patients.
How the SRRR Recommendations are Useful to Funders
These recommendations are very helpful to funders who want to raise the quality of research being funded. We can help ensure this by implementing these new standards and recommendations in our guidance for applicants, and in the peer review and assessment of research, to enable us to make optimally informed funding decisions.
The recommendations that are most useful will depend on the focus and strategy of the funding body. For the UK Stroke Association, we fund mostly clinical research in the form of developmental studies, pilot studies and early-stage feasibility trials. The recommendations around intervention development, measurement in clinical trials, the recovery trial development framework and the measures of upper limb movement will be highly relevant for us to use to ensure we fund robust studies that make a difference to the lives of people with stroke. We expect these recommendations to help us address many of the key weaknesses that we currently see in research applications and will support the research community in improving the quality of their applications to help them win more funding for this crucial, under-funded area. The Canadian Partnership for Stroke Recovery (CPSR) funds preclinical, discovery research and clinical research including clinical trials and knowledge translation. The SRRR guidelines will help us to support high-quality research that is both strategic and translational.
The Stroke Foundation in Australia provides seed grants annually to build research capacity and fostering the current and next generation of leaders. These grants enable researchers to conduct pilot or feasibility studies that will be used to inform a larger nationally competitive grant submission. The SRRR recommendations, particularly in co-design, monitoring the intervention and reporting, will help us to ensure the projects we fund and provide the foundation data for success when competing for larger grants.
How Funders and Researchers Can Work More Closely Together in Future
As research funders, we strongly endorse the international collaborative leadership taken by the SRRR taskforce in coming together and establishing a united approach to raising the quality of stroke recovery and rehabilitation research. However, we require further support from the research community, whether as grant applicants, team leaders and mentors, peer reviewers or funding panel members, to advocate for adherence to these recommendations and ensure they are implementing them in their own reviews, applications and in mentoring the next generation of stroke researchers. The role of the funders will be critical in ensuring clarity regarding our expectations for reviewers and panellists to assist them in delivering continuity and consistency of review outcomes. Funders represent the voice of those impacted by stroke, so the involvement of consumers in research design and addressing a key gap in stroke recovery knowledge is central to securing support for research. As evidence-driven organizations, we produce qualitative and quantitative reports demonstrating gaps in stroke knowledge, treatment and care. Researchers should use these findings to target their research to the areas which consumers feel are more important. But there is a role for the research community too, to take personal responsibility and ensure their own adherence to these new recommendations. Without a general consensus to take this collective and personal responsibility as a community, we will not be able to implement the changes that we know are necessary to advance this field of research.
The Barriers and facilitators for funders in supporting high-quality research
The recommendations of the SRRR address many of the challenges and barriers encountered at every grant funding panel in stroke research: the lack of standardized terminology, methodology, poorly described interventions, inconsistent outcome measures and timeframes, as well as poorly evidenced and inconsistent approaches to develop, monitor and report interventions. If we can encourage researchers to adopt a more consistent approach, we can enhance the robustness of the overall output of this field. Unfortunately, too many applications for funding currently succumb to one or more of the aforementioned pitfalls. Panel reviewers further compound the problem through their own lack of awareness of these recommendations.
These recommendations can help funders enhance the ability of this research field to have a major impact on patient lives in the future – akin to the changes in practice delivered as a result of the successes in acute stroke research. We would like to see the SRRR recommendations being implemented by researchers in their grant writing, and by funders in their grant assessment, to ensure we can move forward into a new world where stroke recovery research is uniformly robust and making a significant difference to the quality of life of those living with stroke.
The UK Stroke Association
The UK Stroke Association provides specialist support, funds critical research and campaigns to make sure people affected by stroke get the very best care and support to rebuild their lives after stroke. We focus our research funding into capacity building in stroke research across multiple disciplines, as well as ensuring we support research that can impact the lives of people with and after stroke. Funding robust and implementable rehabilitation and recovery research is therefore a key priority for us. We will be making the necessary changes to our grant funding processes to support researchers to adopt these new recommendations, and we urge other funders to do so too.
National Stroke Foundation, Australia
The Stroke Foundation is a national charity that partners with the community to prevent, treat and beat stroke. The Stroke Foundation Research Program aims to support and translate high-quality research that will lead to changes in practice, policy and knowledge resulting in prevention of stroke and improved quality of life for stroke survivors, their families and/or carers. We support stroke research in three different ways:
Funding annual research grants to promote stroke research capacity and generate new stroke knowledge.
Building strong partnerships to improve stroke research outcomes.
Leveraging all Stroke Foundation activities to deliver better outcomes for stroke care through research. This includes the consideration of work done in programme planning and evaluation, better use of the extensive data held by the Stroke Foundation and a focus on research priority areas.
Canadian Partnership for Stroke Recovery
The CPSR is a unique, national partnership focused exclusively on stroke recovery. We bring together the top researchers in Canada to collaborate, advance discovery, test new approaches, conduct clinical trials and deliver new knowledge to the people who can apply it. We focus on strategic, translational research and multi-disciplinary training programmes. We used the first SRRR publications as required background preparation for applicants prior to the launch of our most recent funding call. Headquartered at the University of Ottawa, the CPSR is a joint initiative of the Heart and Stroke Foundation and Canada’s leading stroke recovery research centres.
Footnotes
Declaration of Conflicting Interests
Dale Corbett has been an active participant in the SRRR deliberations as well as being Scientific Director of the Canadian Partnership for Stroke Recovery.