national-clinical-guidelines-for-stroke-fourth-edition

National clinical guideline for stroke
6.1.2 Source
strategies or offered treatments to overcome or compensate for any impairment
affecting activities or safety, or causing distress.
A–E Consensus
6.2 Rehabilitation treatment quantity (intensity of therapy)
See section 3.14 for more detail.
6.2.1 Recommendation
A Patients with stroke should be offered a minimum of 45 minutes of each appropriate
therapy that is required, for a minimum of 5 days a week, at a level that enables the
patient to meet their rehabilitation goals for as long as they are continuing to benefit
from the therapy and are able to tolerate it.
6.2.2 Sources
A Consensus; National Institute for Health and Clinical Excellence 2010d
6.3 Evaluating and stopping treatments
The rehabilitation process is cyclical. It starts with problem identification, analysis and
understanding (ie diagnosis of the problems) and moves on to an evaluation of progress
made in terms of the goals set. While the cycle may reiterate several times, as existing
problems are resolved and as new problems are identified, it is appropriate for the process
to end when all achievable goals have been reached and no new attainable goals can be
set. Many stroke survivors report that they continue their recovery many months and
even years after their stroke. Although this does not mean that it is necessarily
appropriate for rehabilitation support to continue, it does mean that access to regular
reviews to assess ongoing needs is vital.
6.3.1 Recommendations
A Every patient should have their progress measured against goals set at regular intervals
determined by their rate of change, for example using goal attainment scaling.
B When a patient’s goal is not achieved, the reason(s) should be established and:
● the goal should be adjusted, or
● the intervention should be adjusted, or
● no further intervention should be given towards that goal and a further goal set as
appropriate.
C When a therapist or team is planning to stop giving rehabilitation, the therapist or
service should:
● discuss the reasons for this decision with the patient and carer
● ensure that any continuing support that the patient needs to maintain and/or
improve health is provided
80 © Royal College of Physicians 2012