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● where appropriate refer the person with stroke on to community organisations
(statutory and non-statutory) that can support the patient in fulfilling their wanted
roles.
B Local commissioners should ensure that community integration and participation for
disabled people is facilitated through:
7.3.2 Sources
● ensuring a suitable community transport system that is accessible and available
● organising and supporting venues for social and leisure activities able to
accommodate disabled people, especially people with communication and
cognitive problems
● organising and supporting social networks for disabled people (eg through
voluntary groups)
● making sure appropriate stroke specialist and generic voluntary sector services and
peer support (eg communication support groups, stroke clubs, self-help groups
and communication partner schemes) are available and that information and
signposting to them are given.
A–B Consensus; National Stroke Strategy quality markers 13 and 15
7.4 Support (practical and emotional)
Many people need considerable care from others after stroke, both for personal
activities such as washing and dressing, and more so for domestic and community
activities. Provision of this support is rarely the responsibility of the healthcare
system, but healthcare teams do have a responsibility to identify and specify the
support needs of each patient, and to help organise this support from the responsible
organisations.
Evidence to recommendations
There is evidence of unmet need in nearly 50% of stroke survivors, between 1 and 5 years
after stroke. This includes problems related to mobility, falls, fatigue, pain, emotion,
memory, reading and concentration (McKevitt et al 2011). Services should ensure that
mechanisms are in place to identify and address such issues. The research evidence to
inform service development and delivery in this area is limited. One approach has been
to employ and train healthcare workers or volunteers (eg a stroke liaison worker) to
provide education and social support (including counselling) and liaison with services
for people with stroke and carers. A meta-analysis of trials of such interventions reported
that these were associated with significant reductions in disability and death in patients
with mild to moderate disability (Ellis et al 2010). There is no trial evidence that they
improve subjective health status or activities of daily living.
7.4.1 Recommendations
7 Long-term management
A Patients and their carers should have their individual practical and emotional support
needs identified:
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