Formal rehabilitation after stroke.

Abstract

About 100 000 first ever strokes occur in Britain each year (2/1000 population/year'); one in four occur in people under 65 years old.

Views of survivors of stroke on benefits of physiotherapy.

“…Several trials have attempted to determine the value of physiotherapy after stroke, but they are not easily comparable.2 3 Trials are rarely randomised; settings are varied (for example, some study inpatient physiotherapy, some outpatient physiotherapy, and some domiciliary physiotherapy); and the content of the treatment is not standardised.4 Moreover, outcome measures are not standardized and do not reflect the full range of rehabilitation aims or include assessments of patient and carer satisfaction.5 The most that can be drawn from these studies is that physiotherapy seems to be associated with modest improvements (according to functional and physical outcome measures) in the first few months after a stroke,3 6 although recent work suggests that there may also be benefits late after a stroke.7 A previous study of ours disclosed that six months after their stroke 85% of people were satisfied with the rehabilitation they had had but that only 46% were satisfied that they had received enough rehabilitation.' However, the study was unable to explain why the majority thought they needed more rehabilitation.…”

The introduction of a routine monitoring system in primary care for patients with a first episode of cardiovascular disease

“…General and nursing care in the community may also enhance rehabilitation immediately after a stroke ( Freemantle et al . 1992 ), and although patients may still have health education needs after discharge from hospital they may be unlikely to seek the required information ( Bostron et al .…”

Developing a District Stroke Service

“…Secondary prevention with aspirin for isch- [12]. Treatm ent of established disease is perhaps more contentious, but there is now evidence to suggest that a properly co-ordinated package of care for patients with stroke is more effective than ad hoc treatm ent pro vided in non-specialist settings [13,14], No drug treat ment for stroke has yet been shown to have more than a marginal impact on stroke mortality and morbidity [15], and the effectiveness of rehabilitation is in question [16,17].…”