Canadian trials network is a launch pad to test new research and improved therapies for stroke recovery

How do you take the latest research, test it, train people to deliver it, and then fast-track the findings into clinics, hospitals and homes across Canada to improve the lives of people living with stroke?

Believe it or not, there’s an answer to that question – and it’s starting to deliver results for people across the country.

First established five years ago and recently expanded to more cities and regions across Canada, CanStroke Recovery Trials is a national launch pad for stroke recovery clinical trials, led by some of the top research experts in the world.

“This uniquely networked platform doesn’t exist anywhere else in the world.”

“We’ve created a Canadian network and we are ready to go,” says CanStroke leader Dr. Sean Dukelow, Professor at the Cumming School of Medicine and Medical Director of Stroke Rehabilitation for the Calgary Stroke Program at Foothills Medical Centre.

Eight trials — ranging from robotics to wearable devices to tele-rehabilitation to novel combinations of drugs and exercise – have rolled out in some of the CanStroke centres across the country. A ninth trial is set to begin that will study the delivery of virtual therapy for post-stroke depression, a common side effect of stroke. A tenth trial is in the planning stages with U.S. funders knocking at the door to take advantage of this uniquely networked platform that doesn’t exist anywhere else in the world.

Dr. Sean Dukelow, accompanied by research coordinator Mark Piitz and PhD student Lydia Kuhl, with the Kinarm robot

Already established in Calgary, Vancouver, Winnipeg, London, Toronto, Halifax and St. John’s, this spring CanStroke Recovery Trials received Brain Canada support to expand to Kelowna, Windsor, Kingston, Quebec City and Charlottetown.

By connecting 40 researcher-clinicians and 20 trial co-ordinators at a dozen sites across Canada, including smaller centres that wouldn’t normally participate in large trials, CanStroke is powering up research and finding new and better ways to boost recovery from stroke.

The urgency to make advances in the field is real. At least 60 per cent of people who experience a stroke are left with a physical or cognitive disability, mobility or speech challenge.

About 900,000 Canadians live with stroke disability, and the number is expected to grow as Canada’s population ages, and as more people survive stroke thanks to lifesaving advances in acute care.

Dr. Dukelow says the promise of CanStroke Recovery Trials comes from the fact that it provides a way to vet and test new ideas and approaches and scale up so that there are enough participants to change the behaviour of frontline clinicians. CanStroke also provides training and resources to help clinicians take research findings and continue to build on them.

“It’s about open science but it’s also about trying to put us two steps ahead.” – Sean Dukelow

“We can tackle questions that require bigger sample sizes and run larger networked trials. If something works in Calgary, we can see if it works in Winnipeg and Vancouver and Toronto and St. John’s, where practice patterns are all a little bit different,” Dr. Dukelow explains. “If the trial is successful, it means we have on-boarded hundreds of clinicians and trained them in that therapy so they can hit the ground running, ensuring a lot of Canadians have access to new approaches.”

In fact, CanStroke is gaining attention in all parts of the globe as a model. And, investigators and industry are approaching the CanStroke team to seek advice on how to structure their trials of novel therapies and devices, and how to work together. “We can make industry’s ability to spool up a trial much more seamless,” Dr. Dukelow says. “A lot of trials have failed in rehabilitation because they are not structured well.”

CanStroke has a platform director, Farrell Leibovitch, headquartered at Sunnybrook in Toronto, scientific leadership in Calgary, Toronto and Vancouver, and site leaders and trial coordinators at each trial hub. The University of Calgary’s Hotchkiss Brain Institute (HBI) is working closely with CanStroke to further grow its impact through the support of donors.

Through CanStroke, “there will be a lot of relatively new clinicians brought into the tent and trained on novel rehabilitation techniques,” says Dr. Dukelow, who works closely with CanStroke’s founding investigators, Dr. Mark Bayley at Toronto Rehabilitation Institute and Dr. Janice Eng of University of British Columbia, as part of the leadership team.

“You have more places in Canada that have the ability to run Health-Canada regulated trials. Does it change practice? For those sites, it does,” Dr. Dukelow says. Patients receive a higher standard of care because sites are monitored more frequently and therapists have extra training.

“Investigators and industry are approaching the CanStroke team to seek advice on how to structure their trials of novel therapies and devices, and how to work together. “We can make industry’s ability to spool up a trial much more seamless,” Dr. Dukelow says. “A lot of trials have failed in rehabilitation because they are not structured well.”

But CanStroke will be even bigger than that. The team is building a knowledge hub to share data, enable researchers to answers more questions, and provide the know-how to build future trials. “It’s about open science but it’s also about trying to put us two steps ahead,” Dr. Dukelow explains.

For more on Brain Canada’s support of the platform, visit: https://braincanada.ca/announcements/new-grant-to-help-build-on-the-success-of-a-brain-canada-funded-platform-for-stroke-recovery/