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

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7.5 People with stroke in care homes 128 7.6 Carers (informal, unpaid) 129 Profession-specific concise guidelines Nursing concise guide 132 Nutrition and dietetics concise guide 140 Occupational therapy concise guide 145 Physiotherapy concise guide 153 Primary care concise guide 160 Psychology concise guide 168 Speech and language therapy concise guide 172 Appendices Appendix 1 Evidence table reviewers 181 Appendix 2 Peer reviewers 183 Appendix 3 National Stroke Strategy quality markers 186 References 189 Index 203 Tables of evidence Available online at www.rcplondon.ac.uk/publications/nationalclinical-guidelines-stroke Contents © Royal College of Physicians 2012 vii
The Intercollegiate Stroke Working Party Chair Professor Anthony Rudd Professor of stroke medicine, King’s College London; consultant stroke physician, Guy’s and St Thomas’ NHS Foundation Trust Associate directors from the Stroke Programme at the Royal College of Physicians Professor Pippa Tyrrell Professor of stroke medicine, University of Manchester; consultant stroke physician, Salford Royal NHS Foundation Trust Dr Geoffrey Cloud Consultant stroke physician, honorary senior lecturer clinical neuroscience, St George’s Healthcare NHS Trust, London Dr Martin James Honorary associate professor, Peninsula College of Medicine and Dentistry; consultant stroke physician, Royal Devon and Exeter Hospital Association of Chartered Physiotherapists In Neurology Mrs Nicola Hancock Lecturer in physiotherapy, Restorative Neurology Group, University of East Anglia AGILE – Professional Network of the Chartered Society of Physiotherapy Miss Louise Briggs Allied health professional therapy consultant, St George’s Healthcare NHS Trust, London Association of British Neurologists Dr Gavin Young Consultant neurologist, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust British Association of Social Workers/National Institute for Health Research School for Social Care Research Professor Jill Manthorpe Professor of social work, King’s College London British Association of Stroke Physicians Dr Neil Baldwin Consultant stroke physician, North Bristol NHS Trust British Association of Stroke Physicians Dr Peter Humphrey Consultant neurologist, Walton Centre for Neurology and Neurosurgery British Society of Rehabilitation Medicine Professor Derick Wade Consultant in rehabilitation medicine, The Oxford Centre for Enablement British Dietetic Association Ms Cheryl Hookway Senior specialist dietitian – stroke, Imperial College Healthcare NHS Trust, London British Dietetic Association Dr Elizabeth Weekes Consultant dietitian and research lead, Guy’s and St Thomas’ NHS Foundation Trust, London British Geriatrics Society/Stroke Research Network Professor Helen Rodgers Professor of stroke care, Newcastle University British Primary Care Neurology Society Dr Helen Hosker Clinical commissioning lead for stroke, NHS Manchester British Psychological Society Dr Peter Knapp Senior lecturer, University of York British Psychological Society Dr Audrey Bowen Senior lecturer in psychology, University of Manchester British Society of Neuroradiologists Dr Andrew Clifton Interventional neuroradiologist, St George’s Healthcare NHS Trust, London Chartered Society of Physiotherapy Dr Cherry Kilbride Lecturer in physiotherapy, Centre for Research in Rehabilitation, Brunel University, London viii © Royal College of Physicians 2012
Page 1 and 2: National clinical guideline for str
Page 3 and 4: The Royal College of Physicians The
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Page 11 and 12: Conflicts of interest All working p
Page 13 and 14: Key recommendations Number Recommen
Page 17 and 18: Acknowledgements The Intercollegiat
Page 19 and 20: Glossary ABCD2 score Prognostic sco
Page 36 and 37: 2 Commissioning of stroke services
Page 38 and 39: 2.1.2 Implications needed by patien
Page 40 and 41: 2.4 Commissioning rehabilitation se
Page 42 and 43: 3 Organisation of stroke services 3
Page 44 and 45: symptoms who screen positive using
Page 46 and 47: ● nursing staff specifically trai
Page 48 and 49: 3.5.1 Recommendation 3.5.2 Source A
Page 50 and 51: 3.8 Transfers of care - discharge f
Page 52 and 53: B Clinicians in all settings should
Page 54 and 55: E have protocols to guide the use o
Page 56 and 57: Evidence to recommendations It is r
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evidence from randomised trials is
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4 Acute phase care 4.0 Introduction
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E All patients with residual neurol
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esources to respond to the need. Pr
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D People with an acute non-disablin
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D Consensus; quality marker eight o
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[K] Any person with acute ischaemic
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prevent rebleeding are urgent. CT s
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anticoagulants including direct thr
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Evidence to recommendations Studies
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● risk of developing skin pressur
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4.16 Positioning Impairment of moto
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section covers only the immediate,
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National clinical guideline for str
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7 Long-term management 7.0 Introduc
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● where appropriate refer the per
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experience appropriate to meet thei
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Profession-specific concise guideli
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● ensure that all relevant inform
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C People with stroke should be offe
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● avoiding the use of overhead ar
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Carers (informal, unpaid) (7.6.1) A
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● any continuing specialist treat
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Lipid-lowering therapy (5.6.1) B Al
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Occupational therapy concise guide
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C Bilateral arm training involving
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● be referred to a specialist in
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problems, such as using notebooks,
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Physiotherapy concise guide for str
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medically unstable, by an appropria
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numerical rating scale), the modifi
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Cognitive impairments - general (6.
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E Patients with suspected TIA who a
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Lipid-lowering therapy (5.6.1) A Al
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● ask about and identify any abso
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formal review at least every 6 mont
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Depression and anxiety (6.35.1) A A
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Perception (6.42.1) A Any person wh
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days per week, at a level that enab
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language function should be assesse
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● organising and supporting venue
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Appendix 1 Evidence table reviewers
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Appendix 2 Peer reviewers Commissio
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Dr Katerina Hilari City University
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QM7 Urgent response All patients wi
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References Abbott AL (2009) Medical
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Cirstea MC, Levin MF (2007) Improve
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Fung TT, Chiuve SE, McCullough ML,
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Koyuncu E, Nakipoglu YG, Dogan A, O
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Mitchell PH, Veith RC, Becker KJ, B
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Rothwell P, Eliasziw M, Gutnikov S,
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therapy for stroke inpatients. Clin
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