Index > Vol. 39/2007 > Iss. 2/March > pp. 97-102 > Abstract
Review article | Stroke

Facilitating recovery: Evidence for organized stroke care

doi: 10.2340/16501977-0043

Abstract:

Despite dramatic advances in the management of thrombo­lysis and acute stroke, organized rehabilitation remains the cornerstone of recovery from stroke. The importance of organized stroke care in facilitating recovery has been recognized for the last 10 years, but it is still unclear how organized rehabilitation contributes to improved outcomes. This paper presents a synthesis of evidence of the benefits of organized care, especially with respect to stroke severity and different types of organized stroke care. It presents an overview of possible processes within organized rehabilitation that may contribute to good outcomes. The role of integrated care pathways within rehabilitation settings is discussed, highlighting the limitations of current evidence and uncertainty about their benefits. Finally, some key challenges have been identified for stroke units in improving rehabilitation outcomes over the next decade and for healthcare planners in investing adequately in organized stroke services.

Authors:

Lalit Kalra and Peter Langhorne

References

  1. Bonita R, Mendis S, Truelsen T, Bogousslavsky J, Toole J, Yatsu F. The global stroke initiative. Lancet Neurol 2004; 3: 391–393. 
.
  2. Anderson CS, Linto J, Stewart-Wynne EG. A population based assessment of the impact and burden of care-giving for long-term stroke survivors. Stroke 1995; 26: 843–849.
  3. National Audit Office. Reducing brain damage: faster access to better stroke care. London: The Stationery Office; 2006. 
.
  4. Wardlaw JM, Zoppo G, Yamaguchi T, Berge E. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2003; CD000213. 
.
  5. Morris DL, Rosamond W, Madden K, Schultz C, Hamilton S. Pre-hospital and emergency department delays after acute stroke. The Genentech Stroke Presentation Survey. Stroke 2000; 31: 2585.
  6. Harraf F, Sharma AK, Brown MM, Lees KR, Vass RI, Kalra L. A multicentre observational study of presentation and early assessment of acute stroke. BMJ 2002; 325: 17–21.
  7. California Acute Stroke Pilot Registry (CASPR) Investigators. Prioritizing interventions to improve rates of thrombolysis for ischemic stroke. Neurology 2005; 64: 654–659. 
.
  8. Weir NU, Buchan AM. A study of the workload and effectiveness of a comprehensive acute stroke service. J Neurol Neurosurg Psychiatry 2005; 76: 863–865. 
.
  9. Diez-Tejedor E, Fuentes B. Acute care in stroke: the importance of early intervention to achieve better brain protection. Cerebrovasc Dis 2004; 17 Suppl 1: 130–137.
  10. Kalra L. The influence of stroke unit rehabilitation on functional recovery from stroke. Stroke 1994; 25: 821–825. 
.
  11. Pineiro R, Pendlebury S, Johansen-Berg H, Matthews PM. Functional MRI detects posterior shifts in primary sensorimotor cortex activation after stroke: evidence of local adaptive reorganization? Stroke 2001; 32: 1134–1139.
  12. Marshall RS, Perera GM, Lazar RM, Krakauer JW, Constantine RC, DeLaPaz RL. Evolution of cortical activation during recovery from corticospinal tract infarction. Stroke 2000; 31: 656–661.
  13. Johansen-Berg H, Dawes H, Guy C, Smith SM, Wade DT, Matthews PM. Correlation between motor improvements and altered fMRI activity after rehabilitative therapy. Brain 2002; 125: 2731–2742.
  14. Wade DT. de Jong BA. Recent advances in rehabilitation. BMJ 2000; 320: 1385–1388. 
.
  15. Langhorne P, Cadilhac D, Feigin V, Grieve R, Liu M. How should stroke services be organised? Lancet Neurol 2002; 1: 62–68. 
.
  16. Stroke Unit Trialists Collaboration. Collaborative systemic review of the randomised trials of organised inpatient (stroke unit) care after stroke. BMJ 1997; 314: 1151–1158.
  17. Organised inpatient (stroke unit) care for stroke. Stroke Unit Trialists’ Collaboration. Cochrane Database Syst Rev 2002; CD000197.
  18. Irwin P, Hoffman A, Lowe D, Pearson M, Rudd AG. Improving clinical practice in stroke through audit: results of three rounds of National Stroke Audit. J Eval Clin Pract 2005; 11: 306–314. 
.
  19. Stegmayr B, Asplund K, Hulter-Asberg K, Norrving B, Peltonen M, Terent A, et al. Stroke units in their natural habitat. Can results of randomised trials be reproduced in routine clinical practice? Stroke 1999; 30: 709–714.
  20. Song F, Altman DG, Glenny AM, Deeks JJ. Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta-analyses. BMJ 2003; 326: 472.
  21. Langhorne P for Stroke Unit Trialists Collaboration. The effect of different types of organised inpatient (stroke unit) care. Cerebrovasc Dis 2005; 19 Suppl 2.
  22. Evans A, Harraf F, Donaldson N, Kalra L. Randomized controlled study of stroke unit care versus stroke team care in different stroke subtypes. Stroke 2002; 33: 449–455. 
.
  23. Briggs DE, Felberg RA, Malkoff MD, Bratina P, Grotta JC. Should mild or moderate stroke patients be admitted to an intensive care unit? Stroke 2001; 32: 871–876. 
.
  24. Kalra L, Eade J. Role of stroke rehabilitation units in managing severe disability after stroke. Stroke 1995; 26: 2031–2034. 
.
  25. Langhorne P for Stroke Unit Trialists Collaboration. The effect of organised inpatient (stroke unit) care on death after stroke. Cerebrovasc Dis 2005; 19 Suppl.
  26. Kalra L, Evans A, Perez I, Knapp M, Donaldson N, Swift CG. Alternative strategies for stroke care: a prospective randomised controlled trial. Lancet 2000; 356: 894–899. 
.
  27. Fjaertoft H, Indredavik B, Lydersen S. Stroke unit care combined with early supported discharge: long-term follow-up of a randomized controlled trial. Stroke 2003; 34: 2687–2691. 
.
  28. Indredavik B, Bakke F, Slordahl SA, Rokseth R, Haheim LL. Stroke unit treatment. 10-year follow-up. Stroke 1999; 30: 1524–1527. 
.
  29. Indredavik B, Bakke F, Slordahl SA, Rokseth R, Haheim LL. Treatment in a combined acute and rehabilitation stroke unit: which aspects are most important? Stroke 1999; 30: 917–923. 
.
  30. Evans A, Perez I, Harraf F, Melbourn A, Steadman J, Donaldson N, Kalra L. Can differences in management processes explain different outcomes between stroke unit and stroke-team care? Lancet 2001; 358: 1586–1592. 
.
  31. Sulch D, Kalra L. Integrated care pathways in stroke management. Age Ageing 2000; 29: 349–352. 
.
  32. Kwan J, Sandercock P. In-hospital care pathways for stroke. Cochrane Database Syst Rev 2004; CD002924. 
.
  33. Bernhardt J, Dewey H, Thrift A, Donnan G. Inactive and alone: physical activity within the first 14 days of acute stroke unit care. Stroke 2004; 35: 1005–1009.
  34. Teasell RW, Kalra L. What’s new in stroke rehabilitation. Stroke 2004; 35: 383–385. 
.
  35. Kalra L, Evans A, Perez I, Melbourn A, Patel A, Knapp M, 
Donaldson N. Training care givers of stroke patients: randomised controlled trial. BMJ 2004; 328: 1099–1101.
  36. McCullagh E, Brigstocke G, Donaldson N, Kalra L. Determinants of caregiving burden and quality of life in caregivers of stroke patients. Stroke 2005; 36: 2181–2186.
  37. Hankey GJ, Warlow CP. Treatment and secondary prevention of stroke: evidence, costs, and effects on individuals and populations. Lancet 1999; 354: 1457–1463. 
.
  38. Drummond M, Manca A, Sculpher M. Increasing the generalizabil ity of economic evaluations: recommendations for the design, analysis, and reporting of studies. Int J Technol Assess Health Care 2005; 21: 165–171. 
.
  39. Patel A, Knapp M, Perez I, Evans A, Kalra L. Alternative strategies for stroke care: cost-effectiveness and cost-utility analyses from a prospective randomized controlled trial. Stroke 2004; 35: 196–203.