Excerpt

The aim of this guideline development group was to review the structure, processes and interventions currently used in rehabilitation care, and to evaluate whether they improve outcomes for people with stroke. Such studies are complex and research methodologies need to be robust. Evaluation of clinical effectiveness needs studies that have robust theoretical underpinnings, capture changes that are relevant to the treatment evaluated and reflect what is important to patients, and be large enough to allow reliable data interpretation. This guideline reviews some of the available interventions that can be used in stroke rehabilitation, and highlights where there are gaps in the evidence. It is not intended to be comprehensive.

Contents

• Guideline development group members
• Acknowledgments
• 1. Introduction
• 2. Development of the guideline
  • 2.1 What is a NICE clinical guideline?
  • 2.2 Remit
  • 2.3 Who developed this guideline?
  • 2.4 What this guideline covers
  • 2.5 What this guideline does not cover
  • 2.6 Relationships between the guideline and other NICE guidance
• 3. Guideline summary
  • 3.1 Key priorities for implementation
  • 3.2 Full list of recommendations
  • 3.3 Key research recommendations
• 4. Methods
  • 4.1 Developing the review questions and outcomes
  • 4.2 Searching for evidence
  • 4.3 Evidence of effectiveness
  • 4.4 Evidence of cost-effectiveness
  • 4.5 Post consultation protocol including modified Delphi methodology
  • 4.6 Developing recommendations
• 5. Organising health and social care for people needing rehabilitation after stroke
  • 5.1 Stroke units
  • 5.2 The core multidisciplinary stroke team
  • 5.3 Health and social care interface
  • 5.4 Transfer of care from hospital to community
• 6. Planning and delivering stroke rehabilitation
  • 6.1 Screening and assessment
  • 6.2 Setting goals for rehabilitation
  • 6.3 Planning rehabilitation
  • 6.4 Intensity of stroke rehabilitation
• 7. Support and information
  • 7.1 Providing support and information
• 8. Cognitive functioning
  • 8.1 Visual neglect
  • 8.2 Memory function
  • 8.3 Attention function
• 9. Emotional functioning
  • 9.1 Psychological therapies
• 10. Vision
  • 10.1 Eye movement therapy
  • 10.2 Diplopia or other ongoing visual symptoms after stroke
• 11. Swallowing
  • 11.1.1 Evidence review: In people after stroke what is the clinical and cost-effectiveness of interventions for swallowing versus alternative interventions/usual care to improve difficulty swallowing (dysphagia)?
  • 11.1.2 Economic Literature review
  • 11.1.3 Evidence statements
  • 11.1.4 Recommendations and link to evidence
• 12. Communication
  • 12.1 Aphasia
  • 12.2 Dysarthria
  • 12.3 Speech and language therapies for dysarthria and apraxia of speech
  • 12.4 Intensity of speech and language therapy
  • 12.5 Listener advice
• 13. Movement
  • 13.1 Strength training
  • 13.2 Fitness Training
  • 13.3 Hand and arm therapies: orthoses for the upper limb
  • 13.4 Electrical stimulation: upper limb
  • 13.5 Constraint induced movement therapy
  • 13.6 Shoulder pain
  • 13.7 Repetitive task training
  • 13.8 Walking therapies: treadmill and treadmill with body weight support
  • 13.9 Electromechanical gait training
  • 13.10 Ankle-foot orthoses
• 14. Self-care
  • 14.1 Intensity of occupational therapy for personal activities of daily living
• 15. Community participation and long term recovery
  • 15.1 Return to work
  • 15.2 Long term health and social support
• 16 Acronyms and abbreviations
• 17 Glossary
• 18 Reference list
• Appendices
  • Appendix A Scope
  • Appendix B Process Protocol
  • Appendix C Declarations of interest
  • Appendix D Literature search strategies
  • Appendix E Review Protocols
  • Appendix F Delphi Methodology Report
  • Appendix G Flowcharts of selected studies
  • Appendix H Clinical evidence tables
  • Appendix I Economic evidence tables
  • Appendix J Forest plots
  • Appendix K Cost Effectiveness Model
  • Appendix L Research Recommendations
  • Appendix M Excluded studies

Funding: National Institute for Health and Care Excellence

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.