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

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Physiotherapy concise guide for stroke 2012 These profession-specific concise guidelines contain recommendations extracted from the National clinical guideline for stroke, 4th edition, which contains over 300 recommendations covering almost every aspect of stroke management. The recommendations for each profession are given with their numbers, so that they can be found in the main guideline. The recommendations below have direct implications for physiotherapists and aim to provide them with ready access to the latest guidance. Specialist stroke services (3.2.1) F Patients who need ongoing inpatient rehabilitation after completion of their acute diagnosis and treatment should be treated in a specialist stroke rehabilitation unit, which should fulfil the following criteria: ● it should be a geographically identified unit ● it should have a coordinated multidisciplinary team that meets at least once a week for the interchange of information about individual patients ● the staff should have specialist expertise in stroke and rehabilitation ● educational programmes and information are provided for staff, patients and carers ● it has agreed management protocols for common problems, based on available evidence. Resources (3.3.1) A Each acute stroke unit should have immediate access to: ● medical staff specially trained in the delivery of acute medical care to stroke patients, including the diagnostic and administrative procedures needed for safe, effective delivery of thrombolysis ● nursing staff specifically trained and competent in the management of acute stroke, covering neurological, general medical and rehabilitation aspects ● imaging and laboratory services ● rehabilitation specialist staff. Stroke services for younger adults (3.6.1) A Younger adults who have had a stroke should be managed within specialist medical and rehabilitation services that: ● recognise and manage the particular physical, psychological and social needs of younger patients with stroke (eg vocational rehabilitation, childcare activities) ● are provided in an environment suited to their specific social needs. Transfers of care – discharge from hospital (3.8.1) E Provide early supported discharge to patients who are able to transfer independently or with the assistance of one person. Early supported discharge should be considered a specialist stroke service and consist of the same intensity and skillmix as available in hospital, without delay in delivery. G Carers of patients unable to transfer independently should receive training in moving and handling and the use of any equipment provided until they are demonstrably able to transfer and position the patient safely in the home environment. H All patients should continue to have access to specialist stroke services after leaving hospital, and should know how to contact them. © Royal College of Physicians 2012 153 Physiotherapy concise guide for stroke 2012
Physiotherapy concise guide for stroke 2012 National clinical guideline for stroke Quality improvement (governance, audit) (3.9.1) B Clinicians in all settings should participate in national stroke audit so that they can compare the clinical and organisational quality of their services against national data and use the results to plan and deliver service improvements. Goal setting (3.12.1) Every patient involved in the rehabilitation process should: A have their feelings, wishes and expectations established and acknowledged B participate in the process of setting goals unless they choose not to or are unable to participate because of the severity of their cognitive or linguistic impairments C be given help to understand the nature and process of goal setting, and be given help (eg using established tools) to define and articulate their personal goals D have goals that: ● are meaningful and relevant to the patient ● are challenging but achievable ● include both short-term (days/weeks) and long-term (weeks/months) targets ● include both single clinicians and also the whole team ● are documented, with specified, timebound measurable outcomes ● have achievement evaluated using goal attainment ● include carers where appropriate ● are used to guide and inform therapy and treatment. Rehabilitation treatment approach (3.13.1) All members of a stroke service should: A use an agreed consistent approach for each problem faced by a patient, ensuring the patient is given the same advice and taught the same technique to ameliorate or overcome it B give as much opportunity as possible for a patient to practise repeatedly and in different settings any tasks or activities that are affected (see section 6.16) C work within their own knowledge, skills, competence and limits in handling patients and using equipment, being taught safe and appropriate ways to move and handle specific patients if necessary. Rehabilitation treatment quantity (intensity of therapy) (3.14.1) 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 per 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. B The team should promote the practice of skills gained in therapy in the patient’s daily routine in a consistent manner and patients should be enabled and encouraged to practise that activity as much as possible. C Therapy assistants and nurses should facilitate practice under the guidance of a qualified therapist. Initial, early rehabilitation assessment (4.13.1) B All patients with any impairment at 24 hours should receive a full multidisciplinary assessment using an agreed procedure or protocol within 5 working days, and this should be documented in the notes. Early mobilisation (4.15.1) A Every patient with reduced mobility following stroke should be regularly assessed by an appropriately trained healthcare professional to determine the most appropriate and safe methods of transfer and mobilisation. B People with acute stroke should be mobilised within 24 hours of stroke onset, unless 154 © Royal College of Physicians 2012
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The Intercollegiate Stroke Working
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Conflicts of interest All working p
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Key recommendations Number Recommen
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Acknowledgements The Intercollegiat
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Glossary ABCD2 score Prognostic sco
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symptoms who screen positive using
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3.8 Transfers of care - discharge f
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B Clinicians in all settings should
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E have protocols to guide the use o
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Evidence to recommendations It is r
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prevent rebleeding are urgent. CT s
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Page 192 and 193: Depression and anxiety (6.35.1) A A
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Page 204 and 205: Appendix 1 Evidence table reviewers
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Page 212 and 213: References Abbott AL (2009) Medical
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