Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Adult Stroke Rehabilitation Care

Abstract

Background-A panel of experts developed stroke rehabilitation guidelines for the Veterans Health Administration andDepartment of Defense Medical Systems. Methods-Starting from previously established guidelines, the panel evaluated published literature through 2002, using criteria developed by the US Preventive Services Task Force. Recommendations were based on evidence from randomized clinical trials, uncontrolled studies, or consensus expert opinion if definitive data were lacking. Results-Recommendations with Level I evidence include the delivery of poststroke care in a multidisciplinary rehabilitation setting or stroke unit, early patient assessment via the NIH Stroke Scale, early initiation of rehabilitation therapies, swallow screening testing for dysphagia, an active secondary stroke prevention program, and proactive prevention of venous thrombi. Standardized assessment tools should be used to develop a comprehensive treatment plan appropriate to each patient's deficits and needs. Medical therapy for depression or emotional lability is strongly recommended. A speech and language pathologist should evaluate communication and related cognitive disorders and provide treatment when indicated. The patient, caregiver, and family are essential members of the rehabilitation team and should be involved in all phases of the rehabilitation process. These recommendations are available in their entirety at http://stroke.ahajournals.org/cgi/content/full/36/9/e100. Evidence tables for each of the recommendations are also in the full document. Conclusions-These recommendations should be equally applicable to stroke patients receiving rehabilitation in all medical system settings and are not based on clinical problems or resources unique to the Federal Medical System.

Comprehensive versus consultative rehabilitation services postacute stroke: Outcomes differ

“…Evidence is growing for stroke. As for effective models of care, it is noteworthy that VHA and Canadian best practice standards for stroke recognize the importance of standard functional assessment and rehabilitative potential evaluation early during hospitalization [51][52]. It is also supported by resources and the use of facilities at the University of Pennsylvania, Philadelphia, Pennsylvania; the Samuel S. Stratton VAMC, Albany, New York; and the North Florida/South Georgia VA Health System, Gainesville, Florida.…”

Clinical protocols related with urinary incontinence post stroke: a literature review

“…8,[11][12][13][14]16,18 Os estudos descritivos e a revisão integrativa têm validade C (baixa) e confiabilidade válida, porém insuficiente para recomendar uma ação. A prática clínica deve ser sustentada nos resultados empíricos produzidos por estudos de evidência aceitável ou, em alternativa, serem sustentados em consensos periciais.…”

“…Quatro estudos consideraram o doente também na fase de sequelas, durante transição do internamento para a comunidade e após a sua permanência no domicilio. 9,14,[18][19] Relativamente à tipologia dos artigos seleccionados, oito são originais, têm por base dados empiricos produzidos em investigações. [9][10][11][14][15][16][17]19 Os restantes são artigos de revisão da literatura.…”

“…[9][10][11][14][15][16][17]19 Os restantes são artigos de revisão da literatura. 8,[12][13]18 No que respeita à caracterização da produção cientifica analisada,os dados revelam que os artigos originais resultam na sua maioria de investigações exploratórias de natureza quantitativa e qualitativa.…”

Motor and Functional Recovery After Stroke

“…[1][2][3][4][5][6] Organization and strategies of the rehabilitation seem to be particularly important because they can be influenced other than natural factors such as stroke location or age of the patient. Whereas in the US guidelines for the management of rehabilitation care are organized by an expert panel and the government, 7 in the European Union there are considerable variations in both rehabilitation care and outcome. 8,9 Within the framework of the research Collaborative Evaluation of Rehabilitation in Stroke across Europe (CERISE), the European Commission funded a multicenter longitudinal cohort study comparing inpatient stroke care and recovery patterns between 4 European rehabilitation centers with a total of 531 patients included.…”