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Establishing an effective stroke service in Central Australia has required locally driven innovation to meet the unique challenges of delivering care across this vast region, including a large remote living Aboriginal population. This region experiences some of the highest stroke incidence rates globally, with higher rates of young stroke, haemorrhagic stroke, and stroke in females. Clinician-led, targeted research is now driving improvements—answering practical, locally relevant questions to ensure the stroke service is not only effective and efficient, but also culturally appropriate and grounded in place, community, and lived experience.
Background:
Stroke remains a major contributor to the health gap between Aboriginal and non-Aboriginal Australians, particularly in rural and remote settings like Central Australia, where access to timely, specialised care is limited. Aboriginal people in this region experience strokes at significantly younger ages, with higher incidence and poorer outcomes.
In response stroke services have been developed. Acute reperfusion therapies have been available at Alice Springs Hospital (ASH) since 2019 supported by a well-established Telestroke service and an acute stroke unit - one of the first sites in Australia to be accredited as a Stroke Capable Regional Hospital. Despite these services, access to acute therapies is still limited, and outcomes continue to be poor.
The vast geography, complex retrieval systems, and disparities in stroke awareness among both healthcare workers and community delay access to critical interventions. Displacement from country, social determinants of health and limited rehabilitation options beyond traditional inpatient settings make stroke recovery challenging. Poor health literacy, engagement with healthcare services, and intercultural communication further hinder secondary prevention.
This had led to a number of locally driven research projects, addressing the distinct epidemiological, logistical, and cultural factors influencing stroke care in this setting.
1.A retrospective audit of young strokes to examine stroke workup and access to PFO closure exploring the drivers of young stroke
2.The two part Stroke Patient Journey study, funded by the Stroke Foundation:
a.A retrospective audit using Value-Focussed Process Engineering describing pre-hospital timelines in stroke patients presenting to ASH to identify targets for improving pre-hospital pathways and access to time-critical care.
b.An exploration of Aboriginal perspectives on stroke symptoms, outcomes, and care pathways. This project uses culturally grounded research methodologies and is co-designed and conducted with the ALOs at ASH, and aims to develop educational material and clinical protocols that are culturally and linguistically appropriate
3.A feasibility study for a Remote Code Stroke model, supported by an NHMRC CRE grant, to optimise per-hospital pathways. The study will use a Phase IIa single-arm design, comparing stroke recognition and treatment to an objective performance criterion based on historical data.
4.Development of a prospective stroke database, including social determinants of health
This work is laying the foundation for future innovations, including mobile brain imaging and biomarker-based diagnostics.
By embedding research within clinical practice and privileging Indigenous knowledge systems, this model exemplifies how local clinician-led research can drive effective, community informed improvements in rural and remote stroke care. |
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