27 janvier 2020

New release from the Canadian Stroke Best Practice Recommendations for Rehabilitation, Recovery and Community Participation following Stroke 2019 sixth edition update

An important update has been released for the Heart & Stroke Canadian Stroke Best Practice Recommendations (CSBPR) for Rehabilitation, Recovery and Community Participation following Stroke module. This module includes two parts:

  • Part One: Rehabilitation and Recovery following Stroke
  • Part Two: Transitions and Community Participation following Stroke

The CSBPR for Part One: Rehabilitation and Recovery following Stroke is applicable to people with a range of impairments and limitations from very mild to very severe. Stroke rehabilitation applies across the continuum of care starting from early rehabilitation assessments soon after the stroke occurs and continuing beyond to ensure that each individual achieves optimal recovery and is able to maintain and sustain recovery and minimize deterioration over time. It applies across all functional domains, including physical, cognitive, psychological and social domains, and across a range of inpatient and community settings. The writing group chairs for these guidelines are Robert Teasell and Nancy M Salbach.

The CSBPR for Part Two: Transitions and Community Participation following Stroke acknowledges the participation of people with stroke, their families and caregivers, health professionals, and the broader community in transitions of care. All members of the healthcare team engaged with people with stroke and their families are responsible for partnerships and collaborations to ensure successful transitions and return to the community following stroke. This responsibility also extends to caregivers. This module emphasizes the importance of support and education that should be provided to people with stroke, their families and caregivers and the need for everyone to work together to develop and implement an individualized care plan. It includes recommendations on participation in the community, including returning to driving, leisure activities and vocation, as well as relationships and sexuality. This module also includes recommendations for people with stroke living in long-term care homes, emphasizing the importance of continuing to provide rehabilitation and community participation in this setting. The writing group chairs for these guidelines are Anita Mountain and Jill Cameron.

The theme of the sixth edition of the CSBPR is Partnerships and Collaborations, which stresses the importance of integration and coordination across the healthcare system to ensure timely and seamless care of people with stroke to optimize recovery and outcomes. This theme is particularly relevant to the Recommendations for Rehabilitation, Recovery and Community Participation following Stroke. The 2019 Heart & Stroke Report which focused on the connections between stroke, vascular cognitive impairment and heart conditions, also highlighted disconnections within the healthcare system including challenges around transitions of care. Click here for the 2019 Heart & Stroke report to learn more.

 Highlights and new additions for 2019

For Part One: Rehabilitation and Recovery following Stroke:

  • The module contents were reviewed by a new Community Consultation and Review Panel (CCRP), consisting of a group of people with stroke, their families, and caregivers, who provided their feedback and insights based on their experiences, which helps to ensure the guidelines are grounded in real life experiences.
  • New recommendations provided to address people who are unable to produce any voluntary muscle activity in the affected upper limb.
  • Updates on the recommendations on the use of slings.
  • More detailed recommendations are provided on biofeedback to improve gait training and improve functional recovery and increased detail on balance-related recommendations.
  • New clinical considerations have been added to each section, acknowledging emerging therapies and consensus-based practices where there is a lack of sufficient evidence to qualify as a recommendation.
  • Significant updates made to recommendations on visual perceptual deficits.

 Part Two: Transitions and Community Participation following Stroke:

  • Addition and revision of comprehensive recommendations for community participation and resuming life roles following stroke. This section addresses the rehabilitation and community participation aspects including return to driving, vocational roles, leisure activities and relationships and sexuality.
  • New clinical considerations have been added to each section, acknowledging emerging therapies and consensus-based practices.
  • Emphasis on the need to include social rehabilitation as an important component of assessments and interventions
  • Inclusion of recommendations that discuss the involvement of Telestroke in transitions of outpatient and community-based care.

The revised CSBPR for RehabilitationRecovery and Community Participation following Stroke, parts one and two have been published in the International Journal of Stroke and are part of the sixth edition of the Heart & Stroke Canadian Stroke Best Practice Recommendations. 

All supporting materials for the Rehabilitation, Recovery and Community Participation following Stroke module, including rationale, system implications, performance measures and knowledge translation resources, are available at www.strokebestpractices.ca.