Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update 2015

TLDR

Stroke rehabilitation is a progressive, goal‑oriented process that enables patients to achieve optimal physical, cognitive, emotional, communicative, social, and functional outcomes, and the 2015 Canadian update summarizes evidence‑based recommendations for multidisciplinary teams caring for the 62,000 annual stroke survivors, of whom 6,500 receive inpatient rehab for a median of 30 days. The update adds a dedicated section on pediatric stroke rehabilitation to address care for patients of all ages. The guidelines were developed to cover both system‑level organization (assessment, units, teams, delivery, outpatient and community care) and specific interventions (upper/lower extremity dysfunction, dysphagia, visual deficits, pain, communication, life roles), with each recommendation graded by evidence level. The updated guidelines incorporate new research areas and stronger evidence, and are expected to standardize care for patients, families, and clinicians in Canada and beyond.

Abstract

Stroke rehabilitation is a progressive, dynamic, goal-orientated process aimed at enabling a person with impairment to reach their optimal physical, cognitive, emotional, communicative, social and/or functional activity level. After a stroke, patients often continue to require rehabilitation for persistent deficits related to spasticity, upper and lower extremity dysfunction, shoulder and central pain, mobility/gait, dysphagia, vision, and communication. Each year in Canada 62,000 people experience a stroke. Among stroke survivors, over 6500 individuals access in-patient stroke rehabilitation and stay a median of 30 days (inter-quartile range 19 to 45 days). The 2015 update of the Canadian Stroke Best Practice Recommendations: Stroke Rehabilitation Practice Guidelines is a comprehensive summary of current evidence-based recommendations for all members of multidisciplinary teams working in a range of settings, who provide care to patients following stroke. These recommendations have been developed to address both the organization of stroke rehabilitation within a system of care (i.e., Initial Rehabilitation Assessment; Stroke Rehabilitation Units; Stroke Rehabilitation Teams; Delivery; Outpatient and Community-Based Rehabilitation), and specific interventions and management in stroke recovery and direct clinical care (i.e., Upper Extremity Dysfunction; Lower Extremity Dysfunction; Dysphagia and Malnutrition; Visual-Perceptual Deficits; Central Pain; Communication; Life Roles). In addition, stroke happens at any age, and therefore a new section has been added to the 2015 update to highlight components of stroke rehabilitation for children who have experienced a stroke, either prenatally, as a newborn, or during childhood. All recommendations have been assigned a level of evidence which reflects the strength and quality of current research evidence available to support the recommendation. The updated Rehabilitation Clinical Practice Guidelines feature several additions that reflect new research areas and stronger evidence for already existing recommendations. It is anticipated that these guidelines will provide direction and standardization for patients, families/caregiver(s), and clinicians within Canada and internationally.