‘Sitting up, lying flat does not help in stroke recovery’

Tribune News Service

Ludhiana, June 22

Stroke or brain attack is the leading cause of death and disability in the world. A trial involving more than 11,000 patients has shown that sitting up or lying flat after a stroke makes no difference for their recovery.

The research led by The George Institute for Global Health was conducted to discover if the bed position of the people with the most common form of stroke (acute ischaemic) reduced death or disability.

National lead principal investigator for the study, Prof Jeyaraj D Pandian, head of neurology at Christian Medical College, said, “Head position does not matter so much over and above good nursing care. It does not help with recovery, mortality or how a patient feels. However, we also found there are no significant harms associated with either lying down flat or sitting up.”

He said, “The study is the largest ever randomised nursing care trial that took place at 114 hospitals in nine countries including the UK, Australia, China, Taiwan, India, Sri Lanka, Chile, Brazil, Colombia.”

Some studies had indicated that lying flat might improve recovery by increasing blood flow in main arteries to the brain, but there were fears it also raised the risk of pneumonia.

Many specialists believe that the way the body is positioned after stroke makes a difference to their patient’s recovery. But, there was really no conclusive evidence to back this belief.

“We know the first 24 hours of care post-stroke is crucial for recovery. So, it is vital to find out if sitting up or lying down flat can make any difference,” he added.

Prof Pandian said patients were either assigned to lie flat with their face upwards or with their head raised to at least 30 degrees during the first 24 hours after being admitted to a hospital for a stroke. They were then assessed 90 days later.

As many as 499 patients were enrolled from India from six stroke centres, including Christian Medical College, Ludhiana; PGIMER, Chandigarh; Dr Ramesh Super-speciality Hospitals, Guntur; SCTIMST Trivandrum; Baby Memorial Hospital, Calicut; and Narayana Hrudayalaya Hospital, Banglore.

Dr Mahesh Kate, a stroke specialist at Christian Medical College, Ludhiana, said results were reassuring for lower to middle income countries, where lying flat was more commonly practiced due to the lack of motorised beds.

“What we found is that patients lying flat were somewhat uncomfortable, but it certainly didn’t make their condition any worse. Our findings suggest a review of current clinical practice guidelines is warranted,” added Prof Pandian.

A majority of patients, who took part in the study, had mild to moderate severity strokes, with an average age of 68 years.

This global trial was funded by National Health and Medical Research Council of Australia.