Evidence-Based Community Stroke Rehabilitation

Abstract

Survival after stroke initially can depend on the acute phase of specialist hospital care; however, the greatest impact on patient health and well-being is from the long-term consequences faced when stroke survivors leave the hospital. Optimal recovery requires the provision of coordinated specialist rehabilitation, not only in the early stages of returning home but also, usually, many months after the stroke. Delivery of stroke specialist care in the patient’s home is increasingly common, particularly as health services face the challenge of reducing costs and are moving care out of expensive hospitals. There is also evidence that rehabilitation in the home environment is more beneficial for patients.1,2 Cumulative research evidence reporting the benefits of a variety of rehabilitative interventions addressing the longer-term consequences of stroke has been summarized in excellent reviews on stroke rehabilitation.3–6 Complementing these are national guidelines from countries such as the United States, Australia, Canada, and the United Kingdom that provide comprehensive guidance on a wide range of treatments that clinicians should consider in the rehabilitation of stroke patients.7–10 These documents also deal with the general organization of services, from managing discharge from hospital to specialist rehabilitation services operating in the community and longer-term care. The purpose of this article is to combine information from research literature and guideline documents and to ask the question, what are the key issues when implementing evidence-based community services in practice? We focus on the need for specialist services for stroke patients once they leave the hospital and highlight tensions between the clinical desires to deliver tailored, complex interventions with the need for clear specifications for leaner services in a period of financial austerity. We identify some of the gaps in the research literature, particularly how to identify what the essential elements of …