According to the American Heart Association (AHA), approximately 50 million stroke survivors worldwide currently cope with significant physical, cognitive, and emotional deficits, and 25% to 74% of these survivors require some assistance. In the October 2010 issue of Stroke, the AHA published a comprehensive scientific statement on nursing and interdisciplinary rehabilitation care for stroke patients. The statement examines the coordination of care and summarizes the best available evidence for post-stroke therapies. Available at http://stroke.ahajournals.org, the statement is intended to help educate nurses and other members of the interdisciplinary team about the potential for recovery in the more chronic phases of stroke care. Healthcare professionals are often unaware of patients’ potential for improvement in the later phases of care.
“Healthcare professionals are often unaware of patients’ potential for improvement in the later phases of care.”
Research has shown that the mortality rate associated with stroke is highest in the first 30 days following the event. As such, it’s critical that stroke care be coordinated from the moment the patient hits the door through all phases of care. Clinicians can make measurable improvements with mortality and quality-of-life issues for these patients by initiating rehabilitation care as early as possible. The AHA statement outlines the role of key members of the interdisciplinary team and emphasizes the diverse skills that are necessary for post-stroke rehabilitation.
A Comprehensive Tool
The AHA statement provides an overview of the evidence for various screening tests and medical treatments, including traditional rehabilitation therapies and newer techniques, such as robot-assisted therapies, electrical stimulation, and weight-assisted treadmill devices. Physicians, nurses, and therapists can find a summary of virtually all treatments given for the rehabilitation of stroke, along with the level of evidence for benefit. It puts into context patients’ medical and functional limitations, as well as their social environment, access to healthcare, and family support. The AHA statement also provides the knowledge and support of how everyone caring for these patients can coordinate their efforts to improve quality of life.
Additionally, the AHA statement discusses approaches to personal and environmental factors and education and support for caregivers. Family members play a vital role in the long-term care of stroke patients. About 75% of stroke patients will be cared for by their family after their event. Caregivers should be active members of the interdisciplinary team with common shared goals for recovery and community reintegration. The statement addresses how these caregivers should be educated to optimize quality of life for patients and strategies to enhance their long-term caregiving capability.
Although the AHA statement presents sound evidence on managing stroke patients for the long term, several areas of research are lacking data and require greater emphasis. For example, the management of depression in the post-stroke phase and communication and cognition need more evidence-based data to guide clinicians. The hope is that more research will further assist our efforts in the care of these patients.
Readings & Resources (click to view)
Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P, Billinger SA; on behalf of the American Heart Association Council on Cardiovascular Nursing and Stroke Council. Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke. 2010;41 [Epud ahead of print 2 Sept 2010]. Available at:http://stroke.ahajournals.org/cgi/reprint/STR.0b013e3181e7512bv1.
Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics–2009: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee [published correction appears in Circulation. 2009;119:e182]. Circulation. 2009;119:e21-e181.
Kalra L, Langhorne P. Facilitating recovery: evidence for organized stroke care. J Rehabil Med. 2007;39:97-102.
World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva, Switzerland: World Health Organization; 2008.