Updated guidelines recommend team approach and rehab programs following strokes

After patients suffer a stroke, their rehabilitation program should include input and coordination from physicians, nurses, family members, therapists, psychologists and others, according to new guidelines from the American Heart Association (AHA) and the American Stroke Association (ASA).

The AHA and ASA recommend that stroke patients undergo treatment at in-patient rehabilitation facilities instead of skilled nursing facilities.

The guidelines were published in Stroke on May 4. They were also endorsed by the American Academy of Physical Medicine and Rehabilitation, American Physical Therapy Association, American Occupational Therapy Association, American Society of Neurorehabilitation and American Congress of Rehabilitation Medicine.

“If the hospital suggests sending your loved one to a skilled nursing facility after a stroke, advocate for the patient to go to an in-patient rehabilitation facility instead – unless there is a good reason not to – such as being medically unable to participate in rehab,” Carolee J. Winstein, PhD, the chair of the guidelines committee, said in a news release. “There is considerable evidence that patients benefit from the team approach in a facility that understands the importance of rehabilitation during the early period after a stroke.”

Although the researchers noted that the relative rate of stroke deaths decreased by 35.8 percent between 2000 and 2010, they mentioned that nearly 800,000 people have a stroke each year. Of the stroke survivors, more than two-thirds receive rehabilitation services when they leave the hospital.

Members of the writing group reviewed articles published through 2014 on adults who suffered strokes.

“Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others,” the researchers wrote. “Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential.
”

The guidelines also suggest that caregivers insist stroke survivors participate in a program on preventing falls before getting discharged from hospital. Patients should also have mobility-tasking training and individually tailored exercise programs, while some should have speech therapy and balance training programs.

In addition, the researchers recommended ideas for future research, including examining multimodal interventions, patient-centered outcomes and prediction models to identify responders and nonresponders to different therapies.

“As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed, but without recognition of their clinical impact and their ability to reduce the risk of downstream medical morbidity caused by immobility, depression, loss of autonomy, and reduced functional independence,” they wrote. “The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. We hope that these guidelines help inform these efforts.”