Management of Adult Stroke Rehabilitation Care: a clinical practice guideline.
Pamela W. Duncan,Richard D. Zorowitz,Barbara E. Bates,John Y. Choi,Jonathan J. Glasberg,Glenn D. Graham,Richard C. Katz,Kerri Lamberty,Dean M. Reker +8 more
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TLDR
A growing body of evidence indicates that patients do better with a well-organized, multidisciplinary approach to post-acute rehabilitation after a stroke, and greater adherence to post–acute stroke rehabilitation guidelines was associated with improved patient outcomes.Abstract:
Stroke is a leading cause of disability in the United States.1 The Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) estimates that 15 000 veterans are hospitalized for stroke each year (VA HSR&D, 1997).
Forty percent of stroke patients are left with moderate functional impairments and 15% to 30% with severe disability.2 Effective rehabilitation interventions initiated early after stroke can enhance the recovery process and minimize functional disability. Improved functional outcomes for patients also contribute to patient satisfaction and reduce potential costly long-term care expenditures.
There are only 45 rehabilitation bed units (RBUs) in the VA today. Many veterans who have a stroke and are admitted to a VA Medical Center will find themselves in a facility that does not offer comprehensive, integrated, multidisciplinary care. In a VA rehabilitation field survey published in December 2000, more than half of the respondents reported that the “rehabilitative care of stroke patients was incomplete, fragmented, and not well coordinated” at sites lacking a RBU (VA Stroke Medical Rehabilitation Questionnaire Results, 2000).
In Department of Defense (DoD) medical treatment facilities, approximately 20 000 active-duty personnel and dependents were seen in 2002 for stroke and stroke-related diagnoses according to ICD-9 coding.3 Comprehensive treatment for stroke patients in DoD medical facilities is given primarily at medical centers. Smaller DoD community hospitals may have limited resources to see both inpatients and outpatients, relying more on the TRICARE network for ongoing stroke rehabilitation services.
A growing body of evidence indicates that patients do better with a well-organized, multidisciplinary approach to post-acute rehabilitation after a stroke.4–6 The VA/DoD Stroke Rehabilitation Working Group only focused on the post–acute stroke rehabilitation care.
Duncan and colleagues7 found that greater adherence to post-acute stroke rehabilitation guidelines was associated with improved patient outcomes and concluded “compliance …read more
Citations
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Journal ArticleDOI
Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association
Carolee J. Winstein,Joel M. Stein,Ross Arena,Barbara E. Bates,Leora R. Cherney,Steven C. Cramer,Frank DeRuyter,Janice J. Eng,Beth E. Fisher,Richard L. Harvey,Catherine E. Lang,Marilyn MacKay-Lyons,Kenneth J. Ottenbacher,Sue Pugh,Mathew J. Reeves,Lorie Richards,William Stiers,Richard D. Zorowitz +17 more
TL;DR: This guideline provides a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence.
Journal ArticleDOI
Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial.
Steven L. Wolf,Carolee J. Winstein,J. Philip Miller,Edward Taub,Gitendra Uswatte,David M. Morris,Carol Giuliani,Kathye E. Light,Deborah S. Nichols-Larsen +8 more
TL;DR: The Extremity Constraint Induced Therapy Evaluation (EXCITE) trial as mentioned in this paper showed that a 2-week program of constraint-induced movement therapy (CIMT) for patients more than 1 year after stroke who maintain some hand and wrist movement can improve upper extremity function that persists for at least 1 year.
Effect of Constraint-Induced Movement Therapy on Upper Extremity Function 3 to 9 Months After Stroke
TL;DR: The Extremity Constraint Induced Therapy Evaluation (EXCITE) trial as discussed by the authors was designed to compare the effects of a 2-week multisite program of CIMT vs usual andcustomary care.
Journal ArticleDOI
Virtual reality for stroke rehabilitation
TL;DR: Evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function is found and the evidence remains mostly low quality when rated using the GRADE system.
Journal ArticleDOI
Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient A Scientific Statement From the American Heart Association
Elaine L. Miller,Laura L. Murray,Lorie Richards,Richard D. Zorowitz,Tamilyn Bakas,Patricia C. Clark,Sandra A. Billinger +6 more
TL;DR: In the United States, the incidence rate of new or recurrent stroke is approximately 795 000 per year, and stroke prevalence for individuals over the age of 20 years is estimated at 6.5 million as discussed by the authors.
References
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Journal ArticleDOI
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.
Aram V. Chobanian,George L. Bakris,Henry R. Black,William C. Cushman,Lee A. Green,Joseph L. Izzo,Daniel W. Jones,Barry J. Materson,Suzanne Oparil,Jackson T. Wright,Edward J. Roccella +10 more
TL;DR: The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated, and empathy builds trust and is a potent motivator.
Journal ArticleDOI
Decision aids for people facing health treatment or screening decisions
Dawn Stacey,Dawn Stacey,Krystina B. Lewis,Michael J. Barry,Carol Bennett,Karen Eden,Margaret Holmes-Rovner,Hilary A. Llewellyn-Thomas,Anne Lyddiatt,Richard Thomson,Lyndal Trevena +10 more
TL;DR: Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication, and those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and the preparation for decision making compared to usual care.
Journal ArticleDOI
The seventh report of the joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. The JNC 7 report
Aram V. Chobanian,George L. Bakris,Henry R. Black,William C. Cushman,Lee A. Green,Joseph L. Izzo,Daniel W. Jones,Barry J. Materson,Suzanne Oparil,J.T. Wright,J. R. Toccella,Edward J. Rocella,Melissa M. Brown +12 more
TL;DR: The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated, and empathy builds trust and is a potent motivator.