Attitudes To Stem Cell-Based Treatments Among Ischemic Stroke Patients

Background: Pre-clinical studies have shown that stem cell therapy (SCT) may improve recovery after stroke, and clinical trials investigating safety are ongoing. It is important to consider stroke patients’ knowledge and attitudes about SCT, as these factors may have implications for the possible clinical use of SCT. Therefore, we examined the knowledge and attitudes about SCT among stroke patients potentially suitable for such therapy. Methods: We recruited consecutive first-ever ischemic stroke patients admitted to Skane University Hospital in Lund, Sweden, in 2009-2011. Included patients were aged 20-75 years, had a National Institutes of Health Stroke Scale (NIHSS) score of 1-18, and underwent DW-MRI within 4 days of stroke onset. Patients with severe comorbidity, contraindications to MRI, and/or infratentorial stroke were excluded. A clinical follow-up was performed after 3-5 years assessing stroke severity (NIHSS), stroke recovery (NIHSS baseline - NIHSS follow-up ; ΔNIHSS), functional status (modified Rankin Scale; mRS), comorbidity (Charlson Comorbidity Index; CCI), and patient-reported outcome (Stroke Impact Scale; SIS). The participants also completed an 8-part questionnaire on knowledge and attitudes about SCT. Results: Of 108 patients at baseline, 84 participated in the follow-up. In total, 12% had prior knowledge of SCT. Also, 63% had positive attitudes towards it. Positive attitudes towards SCT were associated with male sex (crude OR: 3.7; 95% CI: 1.5-9.6; P =0.006) and better patient-reported outcome (crude OR: 1.0; 95% CI: 1.0-1.0; P =0.034). No such associations were found for age, education, functional status and stroke severity at follow-up. Likewise, willingness to participate in clinical SCT trials was associated with male sex (crude OR: 5.4; 95% CI: 1.8-16.2; P =0.003) and a higher degree of stroke recovery (crude OR: 1.3; 95% CI: 1.1-1.7; P =0.005). Conclusions: Our findings may have implications for SCT trials in stroke as most stroke patients had limited knowledge about SCT, indicating a need for patient education programs. The attitudes towards SCT were mostly positive and willingness to participate in SCT trials was associated with male sex and higher degree of stroke recovery, which may affect patient selection.