What is the purpose of a STITCH (Stimulation Therapy to Improve motor function after stroke using Invasive Cortical stimulation and physiotherapy) trial?

From the Guidelines

The STITCH trial is not directly addressed in the provided evidence, but based on the most recent and highest quality study, I recommend focusing on rehabilitation therapy starting as soon as medical stability is reached for stroke patients. When considering the management of stroke patients, it's essential to prioritize rehabilitation therapy, as recommended by the 2024 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines 1.

Key Recommendations

• Rehabilitation therapy should start as soon as medical stability is reached to improve functional outcomes, as there is strong evidence supporting this approach 1.
• Task-specific practice is recommended for improving upper and lower extremity motor function, gait, posture, and activities of daily living, with strong evidence supporting its effectiveness 1.
• Mirror therapy and rhythmic auditory cueing may be considered as adjunctive interventions to improve motor outcomes, although the evidence is weaker 1.

Considerations

• The provided evidence does not directly address the STITCH trial, but it emphasizes the importance of early rehabilitation therapy in stroke patients.
• The guidelines recommend against very early mobilization (within 24-48 hours) and early supported discharge due to insufficient evidence 1.
• Other interventions, such as body-weight support treadmill training and high-intensity interval training, have limited or conflicting evidence supporting their use in stroke rehabilitation 1.

From the Research

Suture-Related Infections and Wound Closure

• Suture-associated surgical site infection (SSI) may develop when bacterial contaminants colonize the suture surface and establish biofilms that are highly resistant to antibiotic treatment 2
• Antimicrobial sutures coated with antiseptics such as triclosan and chlorhexidine have been used to minimize the occurrence of SSI, but new approaches are necessary due to the emergence of resistant strains 2
• The choice of suture material may play a role in wound infection, with some materials showing higher bacterial adherence than others 3

Comparison of Sutures and Staples for Wound Closure

• Sutures resulted in slightly fewer overall wound infections compared to staples, but the evidence was insufficient to state a difference in terms of severe wound infection, grade of satisfaction, and hospital stay 4
• Staples may increase the risk of adverse events, readmission rate, and postoperative pain, but the quality of evidence was low 4

Wound Management and Closure Techniques

• Wound assessment guidelines, including evaluation of the patient's tetanus status, wound complexity and age, decisions as to the use of antibiotics, and closure methods, are important for effective wound management 5
• Different pushing/bearing down methods during the second stage of labor, such as spontaneous pushing versus directed pushing, and delayed pushing versus immediate pushing, have been compared in terms of maternal and neonatal outcomes, but the evidence was mainly of moderate to very low quality 6

Bacterial Adherence to Suture Materials

• A study evaluated bacterial adherence to commonly used suture materials, including poliglecaprone, polypropylene, silk, polyglycolic acid, and antimicrobial polyglycolic acid, using a bioluminescent in vitro model 3
• The results showed that the Vicryl suture had the highest bacterial adherence, and absorbable braided suture should not be used in closure of contaminated wounds or wounds at risk for developing infection 3