Evidence map›Paper›PMID 27610616›Full record

Trial reportPloS one2016

Granulocyte Colony Stimulating Factor and Physiotherapy after Stroke: Results of a Feasibility Randomised Controlled Trial: Stem Cell Trial of Recovery EnhanceMent after Stroke-3 (STEMS-3 ISRCTN16714730).

Nikola Sprigg, Rebecca O'Connor, Lisa Woodhouse, Kailash Krishnan, Timothy J England, Louise A Connell, Marion F Walker, Philip M Bath

Open access · goldAbstract readRandomized Controlled Trial
In one paragraph

Trial report in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
1.5field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Principles and requirements for stroke recovery science.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2021
    Review
  5. Review
  6. Colony-Stimulating Factors on Mobilizing CD34Frontiers in pharmacology · 2021
    Review
  7. Review
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Nikola SpriggStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
Rebecca O'ConnorStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
Lisa WoodhouseStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
Kailash KrishnanStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
Timothy J EnglandDivision of Medical Sciences and GEM, University of Nottingham, Nottingham, United Kingdom.
Louise A ConnellSchool of Health, University of Central Lancashire, Preston, United Kingdom.
Marion F WalkerDivision of Rehabilitation and Ageing, University of Nottingham, Nottingham, United Kingdom.
Philip M BathStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
University of Nottingham · GBUniversity of Central Lancashire · GB

Funding

Department of Health PB-PG-0909-19113Medical Research Council G0501997
6 · The paper itself

Abstract

backgroundGranulocyte-colony stimulating factor (G-CSF) mobilises endogenous haematopoietic stem cells and enhances recovery in experimental stroke. Recovery may also be dependent on an enriched environment and physical activity. G-CSF may have the potential to enhance recovery when used in combination with physiotherapy, in patients with disability late after stroke.

methodsA pilot 2 x 2 factorial randomised (1:1) placebo-controlled trial of G-CSF (double-blind), and/or a 6 week course of physiotherapy, in 60 participants with disability (mRS >1), at least 3 months after stroke. Primary outcome was feasibility, acceptability and tolerability. Secondary outcomes included death, dependency, motor function and quality of life measured 90 and 365 days after enrolment.

resultsRecruitment to the trial was feasible and acceptable; of 118 screened patients, 92 were eligible and 32 declined to participate. 60 patients were recruited between November 2011 and July 2013. All participants received some allocated treatment. Although 29 out of 30 participants received all 5 G-CSF/placebo injections, only 7 of 30 participants received all 18 therapy sessions. G-CSF was well tolerated but associated with a tendency to more adverse events than placebo (16 vs 10 patients, p = 0.12) and serious adverse events (SAE) (9 vs 3, p = 0.10). On average, patients received 14 (out of 18 planned) therapy sessions, interquartile range [12, 17]. Only a minority (23%) of participants completed all physiotherapy sessions, a large proportion of sessions (114 of 540, 21%) were cancelled due to patient (94, 17%) and therapist factors (20, 4%). No significant differences in functional outcomes were detected in either the G-CSF or physiotherapy group at day 90 or 365.

conclusionsDelivery of G-CSF is feasible in chronic stroke. However, the study failed to demonstrate feasibility for delivering additional physiotherapy sessions late after stroke therefore a definitive study using this trial design is not supported. Future work should occur earlier after stroke, alongside on-going clinical rehabilitation.

trial registrationISRCTN.com ISRCTN16714730.

Indexed as

Physical Therapy ModalitiesAgedCombined Modality TherapyFemaleGranulocyte Colony-Stimulating FactorHumansMaleMiddle AgedPersons with DisabilitiesStrokeStroke RehabilitationTime FactorsTreatment OutcomeGranulocyte Colony-Stimulating Factor

Identifiers

PMID27610616
PMCPMC5017715
OpenAlexW2509867246

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.