Priority 14 Stroke Prevention, Diagnosis, Pre-hospital and Hospital Care

UNCERTAINTY: What is the best body positioning for patients with stroke in the first hours after stroke?  (JLA PSP Priority 14)
Overall ranking 14
JLA question ID 0106/14a
Explanatory note

There is some evidence that good positioning in the bed after a stroke can improve outcomes. However, the HeadPost Trial [Ref. 13] looked at the best positioning for the head for 24 hours after stroke (i.e. lying flat or sitting up) and did not find any significant difference.  High quality evidence is needed to find the best body positioning early after stroke to inform clinical guidelines and improve stroke outcomes at this critical time.  

Ref 13: https://www.nejm.org/doi/full/10.1056/NEJMoa1615715, 2017
Evidence

No evidence identified 
Health Research Classification System category Stroke
Extra information provided by this PSP
Original uncertainty examples How can stroke services ensure that patients with acute stroke have an initial specialist assessment for positioning as soon as possible and within 4 hours of arrival at hospital? ~  How can stroke services ensure that when lying or sitting, patients with acute stroke are be positioned to minimise the risk of aspiration and other respiratory complications, shoulder pain and subluxation, contractures and skin pressure ulceration? 
Submitted by  Research Recommendations x 3
PSP information
PSP unique ID 0106
PSP name Stroke prevention, diagnosis, pre-hospital and hospital care
Total number of uncertainties identified by this PSP. 93  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 30th April 2021