Stroke Rehabilitation 2007: What Should it Be?

2007 ◽  
Vol 2 (3) ◽  
pp. 191-200 ◽  
Author(s):  
Helen M. Dewey ◽  
Lisa J. Sherry ◽  
Janice M. Collier
Keyword(s):  
Stroke Unit ◽  
Stroke Rehabilitation ◽  
Number Needed To Treat ◽  
Stroke Patients ◽  
High Quality ◽  
High Quality Research ◽  
Stroke Units ◽  
Proven Efficacy ◽  
Stroke Unit Care ◽  
Medical Wards

Background There are an estimated 62 million stroke survivors worldwide. The majority will have long-term disability. Despite this reality, there have been few large, high-quality randomized controlled trials of stroke rehabilitation interventions. Summary of review There is excellent evidence for the effectiveness of a number of stroke rehabilitation interventions, notably care of stroke patients in inpatient stroke units and stroke rehabilitation units providing organized, goal-focused care via a multidisciplinary team. Stroke units (in comparison with care on general medical wards) effectively reduce death and disability with the number needed to treat to prevent one person from failing to regain independence being 20. Unfortunately, only a minority of stroke patients have access to stroke unit care. The key principles of effective stroke rehabilitation have been identified. These include ( 1 ) a functional approach targeted at specific activities e.g. walking, activities of daily living, ( 2 ) frequent and intense practice, and ( 3 ) commencement in the first days or weeks after stroke. Conclusion The most effective approaches to restoration of brain function after stroke remain unknown and there is an urgent need for more high-quality research. In the meantime, simple, broadly applicable stroke rehabilitation interventions with proven efficacy, particularly stroke unit care, must be applied more widely.

scholarly journals The Stroke Unit Story: Where Have We Been and Where Are We Going?

2021 ◽  
pp. 1-8
Author(s):  
Peter Langhorne
Keyword(s):  
Collaborative Research ◽  
Stroke Unit ◽  
Final Section ◽  
Evidence Base ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Stroke Units ◽  
History Of ◽  
Stroke Unit Care ◽  
Stroke Type

<b><i>Background:</i></b> The concept of stroke unit care has been discussed for over 50 years, but it is only in the last 25 years that clear evidence of its effectiveness has emerged to inform these discussions. <b><i>Summary:</i></b> This review outlines the history of the concept of stroke units to improve recovery after stroke and their evaluation in clinical trials. It describes the first systematic review of stroke unit trials published in 1993, the establishment of a collaborative research group (the Stroke Unit Trialists’ Collaboration), the subsequent analyses and updates of the evidence base, and the efforts to implement stroke unit care in routine settings. The final section considers some of the remaining challenges in this area of research and clinical practice. <b><i>Key Messages:</i></b> Good quality evidence confirms that stroke patients who are looked after in a stroke unit are more likely to survive and be independent and living at home 1 year after their stroke. The apparent benefits are independent of patient age, sex, stroke type, or initial stroke severity. The benefits are most obvious in units based in a discrete ward (stroke ward). The current challenges include integrating effective stroke units with more recent systems to deliver hyper-acute stroke interventions and implementing stroke units in lower resource regions.

Stroke units: research in practice

2015 ◽  
Author(s):  
Lalit Kalra
Keyword(s):  
Stroke Unit ◽  
Stroke Care ◽  
Evidence Base ◽  
Multidisciplinary Teams ◽  
Stroke Patients ◽  
Stroke Units ◽  
Key Points ◽  
Stroke Unit Care ◽  
Rehabilitation Needs ◽  
Therapy Sessions

Key points• Stroke units are the cornerstone of quality stroke care.• The benefits of stroke unit care are supported by a very strong evidence base• In 2007 the National Stroke Strategy mandated that all stroke patients should have prompt access to stroke unit care.• Despite policy and guidelines, only 62% stroke patients were treated on specialist stroke units in 2010.• Patients spend long periods of inactivity on stroke units; multidisciplinary teams need to encourage rehabilitation activities outside therapy sessions.• Rehabilitation needs to be family- and carer-oriented to prepare patients for life after discharge.

Abstract T P259: What Should Really be Happening to Our Stroke Patients Post-Acute Care?: A System Best Practice Model for Inpatient Rehab

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Shelley Sharp ◽  
Elizabeth Linkewich ◽  
Jacqueline Willems ◽  
Nicola Tahair ◽  
Charissa Levy ◽  
...  
Keyword(s):  
Acute Care ◽  
Stroke Unit ◽  
Best Practice ◽  
Patient Flow ◽  
System Capacity ◽  
Stroke Patients ◽  
Practice Model ◽  
Term Care ◽  
Stroke Unit Care ◽  
The Right

Background: A regional Stroke Report Card identified poor performance on system efficiency, effectiveness, and integration of stroke best practice. This engaged regional funders and 17 organizations (11 acute, 6 rehab) to collaborate in stroke system planning. The focus included stroke unit care and access to timely and appropriate rehabilitation, including increased access for severe stroke. Changes in acute care, including pre-hospital, have facilitated access to stroke unit care in the city. A model of patient flow from acute care was needed to understand other system capacity needs. Purpose: To use best practice and benchmarks to delineate post-acute patient flow and facilitate alignment of resources for inpatient rehabilitation. Methods: Administrative data from national reporting and local rehab referral system databases were used to review current system usage from acute care. A model of proportional distribution of cases from acute, specifically to inpatient rehab, was established using provincial benchmarks, evidence informed targets, and organization market share of total inpatient rehab system capacity. Iterative discussions were required to confirm the organizations’ commitment to stroke best practice. New volume and case mix changes were applied to determine capacity and resource planning needs across organizations. Results: The best practice model, approved by all stakeholders, proposes 40% of stroke patients discharged alive from acute care should access inpatient, 13% outpatient rehabilitation and 6% to Complex Continuing Care and Long Term Care. Current practice is 26%, <5% and 13% respectively. A projected volume increase of 278 patients is distributed across 5/6 rehab providers. This results in a total proportional system shift from 20% (n=160) to 41.5% (n =446) of severe patients receiving access to high intensity rehab. A reduction in the overall proportion of moderate and mild stroke patients from 65% (519) to 49.5% (n=534) and 15% (n=119) to 9% (n=96) respectively. Conclusion: Significant investment/redistribution of resources within the system is required to support patient flow and provide care in the right place at the right time. System funder support is critical to create a quality of care (best practice) system.

scholarly journals European Stroke Organisation certification of stroke units and stroke centres

2018 ◽  
Vol 3 (3) ◽  
pp. 220-226 ◽  
Author(s):  
Ulrike Waje-Andreassen ◽  
Darius G Nabavi ◽  
Stefan T Engelter ◽  
Diederik WJ Dippel ◽  
Damian Jenkinson ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Care ◽  
Evidence Base ◽  
Final Decision ◽  
Major Step ◽  
High Quality ◽  
Stroke Units ◽  
Stroke Treatment ◽  
Research Activities ◽  
Stroke Centre

To improve quality and to overcome the wide discrepancies in stroke care both within- and between European countries, the European Stroke Organisation Executive Committee initiated in 2007 activities to establish certification processes for stroke units and stroke centres. The rapidly expanding evidence base in stroke care provided the mandate for the European Stroke Organisation Stroke Unit-Committee to develop certification procedures for stroke units and stroke centres with the goals of setting standards for stroke treatment in Europe, improving quality and minimising variation. The purpose of this article is to present the certification criteria and the auditing process for stroke units and stroke centres that aim to standardise and harmonise care for stroke patients, and hence become members of the European Stroke Organisation Stroke Unit and Stroke Centre network. Standardised application forms and guidelines for national and international auditors have been developed and updated by members of the European Stroke Organisation Stroke Unit-Committee. Key features are availability of trained personnel, diagnostic equipment, acute treatment and collaboration with other stroke-caregivers. After submission, the application is reviewed by one national and two international auditors. Based on their reports, the Stroke Unit-Committee will make a final decision. Validating on-site visits for a subset of stroke units and stroke centres are planned. We herein describe a novel, European Stroke Organisation-based online certification process of stroke units and stroke centres. This is a major step forward towards high-quality stroke care across Europe. The additional value by connecting high-quality European Stroke Organisation Stroke Unit and Stroke Centre is facilitation of future collaboration and research activities, enabling building and maintenance of a high-quality stroke care network in Europe.

scholarly journals Beneficial Effects of Stroke-Unit Care in Stroke Patients with Atrial Fibrillation

2013 ◽  
Vol 54 (2) ◽  
pp. 301 ◽  
Author(s):  
Hye-Yeon Choi ◽  
Joo Hyun Seo ◽  
Jae Hoon Yang ◽  
Young Dae Kim ◽  
Yo Han Jung ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Unit ◽  
Stroke Patients ◽  
Beneficial Effects ◽  
Stroke Unit Care

Systematic review of economic evidence on stroke rehabilitation services

2005 ◽  
Vol 21 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Bruce K. Brady ◽  
Lynda McGahan ◽  
Becky Skidmore
Keyword(s):  
Usual Care ◽  
Stroke Unit ◽  
Stroke Rehabilitation ◽  
Rehabilitation Services ◽  
Economic Evidence ◽  
Relative Cost ◽  
Community Based ◽  
Total Cost ◽  
Community Based Rehabilitation ◽  
Stroke Unit Care

Objectives: Given the resource-intensive nature of stroke rehabilitation, it is important that services be delivered in an evidence-based and cost-efficient manner. The objective of this review was to assess the evidence on the relative cost or cost-effectiveness of three rehabilitation services after stroke: stroke unit care versus care on another hospital ward, early supported discharge (ESD) services versus “usual care,” and community or home-based rehabilitation versus “usual care.”Methods:A systematic literature review of cost analyses or economic evaluations was performed. Study characteristics and results (including mean total cost per patient) were summarized. The level of evidence concerning relative cost or cost-effectiveness for each service type was determined qualitatively.Results:Fifteen studies met the inclusion criteria: three on stroke unit care, eight on ESD services, and four on community-based rehabilitation. All were classified as cost-consequences analysis or cost analysis. The time horizon was generally short (1 year or less). The comparators and the scope of costs varied between studies.Conclusions:There was “some” evidence that the mean total cost per patient of rehabilitation in a stroke unit is comparable to care provided in another hospital ward. There is “moderate” evidence that ESD services provide care at modestly lower total costs than usual care for stroke patients with mild or moderate disability. There was “insufficient” evidence concerning the cost of community-based rehabilitation compared with usual care. Several methodological problems were encountered when analyzing the economic evidence.

scholarly journals Stroke in neurological services in Italy

2009 ◽  
Vol 1 (1) ◽  
pp. 8 ◽  
Author(s):  
Fabrizio Antonio De Falco ◽  
Maurizio A. Leone ◽  
Ettore Beghi
Keyword(s):  
Multivariate Analysis ◽  
Ct Scan ◽  
Stroke Unit ◽  
Emergency Setting ◽  
Discharge Diagnosis ◽  
Stroke Patients ◽  
Stroke Units ◽  
Very High ◽  
Italian Neurological ◽  
Structured Questionnaire

o assess the stroke workload of Italian neurological services and to correlate it with indicators of each hospital’s emergency setting. A semi-structured questionnaire was sent to the 220 neurology units (NU) located in hospitals with an emergency room (ER) (155 responders, 71%). Stroke was the most common discharge diagnosis (29%) (273 patients/year/NU on average) and condition requiring consultation in ER (28%). A stroke unit was available in 28% of NU, bedside monitors in 45%, a 24 hour/day and 7 day/week (24/7) CT scan in 90%, a 24/7-MRI in 32%, a 24/7 on-duty neurologist in 36%. The stroke workload was correlated only with the number of ER consultations per year, and marginally to the presence of stroke units and the number of monitored beds in the univariate, but not in the multivariate analysis. The stroke workload in Italian NU is very high, but is largely unrelated to their structural and functional characteristics, in contrast with the international indications requiring several essential criteria for the best hospital management of all stroke patients.

scholarly journals Stroke unities: the role of the occupational therapist and the perception of the multidisciplinary team

2021 ◽  
Vol 4 (6) ◽  
pp. 102-105
Author(s):  
António Arsénio Duarte ◽  
Ana Paula Martin ◽  
Diana Santos ◽  
Rafael Santos ◽  
Rita Viegas
Keyword(s):  
Acute Stroke ◽  
Multidisciplinary Team ◽  
Stroke Unit ◽  
Occupational Therapist ◽  
Medical Emergency ◽  
Structured Interviews ◽  
Stroke Patients ◽  
Stroke Units ◽  
The World

Every second a person in the world suffers from a stroke, not surprising, therefore, that stroke is the leading cause of death and morbidity in Portugal. Increasingly, acute stroke is considered a medical emergency. The evidence proves that the treatment of these patients in specialized units (stroke units) is effective in acute stroke. A stroke unit is a hospital area where professionals with specific, well-defined training work, who provide care to stroke patients who are already stabilized, but are still in an acute phase(DGS, 2001). The aim of this study is to understand the role of the occupational therapist in stroke units and to identify the perspective of the multidisciplinary team on their work, clarifying what are the advantages of this professional in the team. The study falls within the qualitative paradigm, exploratory and descriptive. Semi-structured interviews were performed to 39 health professionals. The technique used was the content analysis of interviews. Based on previously established categories, other categories emerged.

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