e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-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. Communication and coordination among these team members are paramount in maximizing the effectiveness

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OBJECTIVES-To determine how advanced age influences prosthetic prescription. DESIGN-Retrospective cohort analysis with theory-driven logistic regression models. A PostAmputation Quality-of-Life (PAQ) framework of outcomes was proposed and empirically tested. SETTING-Veterans Affairs Medical Centers. PARTICIPANTS-Two MEASUREMENTS-Prosthetic prescription within 1 year of amputation.RESULTS-Patients younger than 76 were 4.5 times as likely to receive a prescription compared to those aged 86 and older (odds ratio = 4.51, 95% confidence interval = 1.36-14.99) after controlling for sex, marital status, living circumstance before hospitalization, anatomical level, etiologies, comorbidities, medical acuity, and initial functional status. Patients admitted from extended care and patients with peripheral vascular disease, systemic sepsis, renal failure, congestive heart failure, psychoses, metastatic cancer, paralysis, or other neurological disorders were less likely to receive a prescription, as were patients who underwent procedures for acute central nervous system disorders, severe renal disease, or serious nutritional compromise. Veterans evaluated initially as more cognitively and physically able had higher likelihood of prosthetic prescription, and those with transtibial amputations had higher likelihood of prosthetic prescription than those with transfemoral amputations. Ralston-Penn, Center, 3615 Chestnut Street, Philadelphia, PA 19104. mstinema@mail.med.upenn.edu. Author Contributions: Jibby E. Kurichi contributed to interpretation of the data and wrote the manuscript. Pui L. Kwong conducted the statistical analyses and contributed to interpretation of the data. Dean M. Reker assisted in acquiring the data and contributed to interpretation of the data and writing of the manuscript. Barbara E. Bates helped to conceive the study concept and design and contributed to the writing of the manuscript. Clifford R. Marshall aided in the acquisition of the data. Margaret G. Stineman helped to conceive the study concept and design, aided in interpretation of the data, and contributed to the writing of the manuscript. Sponsor's Role: None. Depending on the population studied, prosthetic fitting rates have ranged from 27% to 86%. 1,4,[11][12][13][14] Younger patients and those undergoing transtibial amputations compared to older patients and those undergoing transfemoral amputations are more likely to receive a prosthesis. 1 Those with oncological metastases, wound healing problems, 14 and dementia and those receiving renal dialysis 2 tend not to perform well and are less likely to be fitted with a prosthetic limb. NIH Public AccessA Post Amputation Quality-of-Life (PAQ) framework for organizing patient-related factors available from administrative records into clinically meaningful domains to predict patient outcomes and patterns of resource use was proposed and tested. The framework is intended to bridge the surgical episode with rehabilitation processes, capturing the full continuum of care. Linkable administrat...