HeadPoST: Rightly positioned, or flat out wrong?

Anne W Alexandrov; Georgios Tsivgoulis; Michael D Hill; David S Liebeskind; Peter Schellinger; Bruce Ovbiagele; Adam S Arthur; Valeria Caso; Raul G Nogueira; J Claude Hemphill 3rd; James C Grotta; Werner Hacke; Andrei V Alexandrov

doi:10.1212/WNL.0000000000005481

HeadPoST: Rightly positioned, or flat out wrong?

Neurology. 2018 May 8;90(19):885-889. doi: 10.1212/WNL.0000000000005481. Epub 2018 Apr 11.

Affiliations

¹ From the Department of Acute Care, College of Nursing (A.W.A.), and Departments of Neurology (A.W.A., G.T., A.V.A.) and Neurosurgery (A.S.A.), College of Medicine, University of Tennessee Health Science Center at Memphis; Second Department of Neurology (G.T.), National & Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Greece; Department of Clinical Neuroscience (M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurology (D.S.L.), University of California at Los Angeles; Department of Neurology and Neurogeriatrics (P.S.), Johannes Wesling Medical Center, Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Neurology (B.O.), Medical University of South Carolina, Charleston; Semmes Murphy Brain and Spine Institute (A.S.A.), Memphis, TN; Stroke Unit (V.C.), Santa Maria Della Misericordia Hospital, University of Perugia, Italy; Marcus Stroke and Neuroscience Center (R.G.N.), Grady Memorial Hospital, School of Medicine, Emory University, Atlanta, GA; Department of Neurology (J.C.H.), University of California at San Francisco; Memorial Hermann Hospital (J.C.G.), Houston, TX; and Department of Neurology (W.H.), University of Heidelberg, Germany. [email protected].
² From the Department of Acute Care, College of Nursing (A.W.A.), and Departments of Neurology (A.W.A., G.T., A.V.A.) and Neurosurgery (A.S.A.), College of Medicine, University of Tennessee Health Science Center at Memphis; Second Department of Neurology (G.T.), National & Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Greece; Department of Clinical Neuroscience (M.D.H.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurology (D.S.L.), University of California at Los Angeles; Department of Neurology and Neurogeriatrics (P.S.), Johannes Wesling Medical Center, Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Neurology (B.O.), Medical University of South Carolina, Charleston; Semmes Murphy Brain and Spine Institute (A.S.A.), Memphis, TN; Stroke Unit (V.C.), Santa Maria Della Misericordia Hospital, University of Perugia, Italy; Marcus Stroke and Neuroscience Center (R.G.N.), Grady Memorial Hospital, School of Medicine, Emory University, Atlanta, GA; Department of Neurology (J.C.H.), University of California at San Francisco; Memorial Hermann Hospital (J.C.G.), Houston, TX; and Department of Neurology (W.H.), University of Heidelberg, Germany.

PMID: 29643083
DOI: 10.1212/WNL.0000000000005481

Abstract

Objective: To critique the Head Positioning in Stroke Trial (HeadPoST) study methods in relation to preceding research findings in an aim to clarify the potential efficacy of positioning interventions and direction for future research.

Methods: Head positioning research prior to the conduct of HeadPoST was reviewed by a team of international stroke experts, and methods and findings were compared to HeadPoST.

Results: Methods used to select HeadPoST patients differ substantially from those used in original head positioning studies, in particular enrollment of all types of stroke. HeadPoST enrolled primarily minor strokes (median NIH Stroke Scale 4, interquartile range [IQR] 2-8) without vascular imaging confirmation of subtype; elapsed time from stroke symptom onset to the initiation of intervention was late (median 14 hours, IQR 5-35), and time from hospital admission to enrollment was delayed (median 7 hours, IQR 2-26). Intervention integrity was not reported, including ability to achieve/maintain 30° head elevation in beds lacking head elevation capabilities. Deterioration or improvement associated with the intervention is unknown as serial assessments were not completed, and the trial's 3-month outcome was powered using unrelated study data.

Conclusions: The design of HeadPoST was suboptimal to measure differences produced by the intervention. Future head positioning trials in discrete patient cohorts (in particular, large vessel occlusion) with endpoints supported by pilot work are required to understand the efficacy of this simple yet potentially important intervention.

Publication types

Review

MeSH terms

Brain Ischemia / complications
Cerebral Hemorrhage / therapy*
Cerebrovascular Circulation / physiology*
Female
Humans
Male
Patient Positioning*
Posture
Randomized Controlled Trials as Topic
Stroke / etiology
Stroke / therapy*
Treatment Outcome