People with stroke should receive at least 45 minutes of each appropriate therapy a day, guidance from the Royal College of Physicians (RCP) recommends.
Nicola Hancock: The guidelines were developed using a rigorous process of searching and appraising evidence about stroke care
Rehabilitation is central to the document, which says the frequency of therapy must enable stroke patients to meet their rehabilitation goals. And, very importantly, therapy should continue as long as patients are willing and capable of participating and showing measurable benefit from treatment.
The RCP’s Key Recommendations for Stroke 2016 offers a concise guide to better stroke care. Its 30 recommendations are based on the RCP’s detailed 151-page National Clinical Guideline for Stroke, with more than 400 recommendations covering almost every aspect of stroke management.
A stroke unit must be capable of providing rehabilitation to all its patients, it tells commissioners. In addition, it calls on them to provide a specialist early supported discharge service, so stroke patients can continue their rehabilitation at home.
Commissioners are recommended to look for specialist rehabilitation services which meet the specific health, social and vocational needs of people with stroke of all ages. And they should commission services capable of delivering specialist rehabilitation in out-patient and community settings, in liaison with inpatient services.
Early mobilisation is key, the document says. Patients who are medically stable but have difficulty moving soon after a stroke should be offered frequent, short, daily mobilisations by appropriately trained staff. Typically this should begin between 24 and 48 hours after a stroke.
Inpatient stroke units should be staffed by a multidisciplinary team that meets at least once each week to exchange information about patients.
Nicola Hancock, lecturer in physiotherapy at the University of East Anglia, contributed to the guidance. She said physiotherapists would find the concise guidance highly accessible and hoped it would be used, along with the full guidelines, to inform, support and improve acute and rehabilitation services.
'The new National Clinical Guideline for Stroke is the most comprehensive, evidence-based tool available to guide practice all the way through the stroke pathway, from the earliest stages to long-term management of this important condition,’ she said.
‘The guidelines were developed using a highly-rigorous process of searching, appraising and compiling the evidence. The concise guide brings together a number of guidelines from the main document that are particularly relevant to physiotherapy practice.’
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