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Rehabilitation guideline for stroke victims launched by NICE

Author: Neil Fearn  Bullet  Dated: 11/07/2013

To improve outcomes for almost 1 million people in the UK laid low by strokes, the National Institute for Health and Care Excellence (NICE) has published a new guideline.

Better overall care for the 125,000 people afflicted annually has seen a marked improvement in the stroke survival rate. However, NICE has estimated that over 900,000 continue to suffer long-term disabilities.

Targeted and specialised care for stroke victims

To encourage the gaining of new skills or the refreshment of old ones, the healthcare body says sufferers should receive "targeted therapy" while residing in specialist inpatient units straight after strokes occur. On returning home, care should be delivered by specialist community stroke teams.

Professor Mark Baker, a director of clinical practice at NICE, said people's lives have been "devastated" by the lasting impact of strokes.

"This guideline makes practical recommendations about what should be provided as part of a comprehensive stroke rehabilitation service, what reviews and reassessments should be carried out, and what additional information, support or care to consider when delivering services or therapies," Prof Baker commented.

NICE acknowledged that its new guidance does not cover in detail every area of stroke rehabilitation.

The number of stroke survivors has risen steadily in the last 50 years, with the arrival of specialist stroke units a contributory factor. Anti-clotting medication and the realignment of services to ensure better delivery of drugs have also played their part.

In spite of the improvements, however, nearly a 3rd of stroke victims will suffer from continued disability. As a consequence, access to proper rehabilitation facilities will be essential – a situation NICE hopes to foster in the coming years.

Key priorities in the guidelines

The key areas of focus as recognised by NICE in the guidelines are:

  • A patient with residual disability post-stroke should receive rehabilitation care in a dedicated specialist unit, followed by care from a community stroke team
  • Early supported discharge from the special unit should be offered to stroke sufferers who can transfer from beds to chairs independently or with assistance, provided they will be in a safe, secure environment
  • A minimum of three-quarters of an hour for at least 5 days should be set aside for each rehabilitation therapy to those who can participate and where functional goals can be attained.
  • If further rehabilitation is required later, its intensity should be geared to the patient's needs at that time
  • Therapy should be available at least 3 times weekly to people who have difficulty swallowing following a stroke, provided they are able to participate
  • Prompt identification of return-to-work issues, with regular reviews and active management

Prof Baker noted that the single greatest contributor to complex impairment in England is stroke.

"That burden may increase as the population ages," Prof Baker said. "Although there is little doubt the overall approach to stroke rehabilitation is effective, there is less clarity about the clinical and cost effectiveness of the individual interventions within this overall structure.

"With patients and carers very much at its centre this guideline addresses this issue and will contribute to the provision of better care for people who have had a stroke."

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