- The US Department of Veterans Affairs (VA) and the US Department of Defense (DoD) have updated their joint guidelines on stroke rehabilitation.
Why this matters
- Stroke sequelae such as disability and spasticity can be improved by early, appropriate rehabilitation.
- New evidence has emerged since the guidelines were last published almost a decade ago.
- Guidelines focus on acute and long-term rehabilitation of the stroke patient, apply to clinicians in both primary care and rehabilitation.
- 6 topic areas:
- Timing and approach.
- Motor therapy.
- Cognitive, speech, and sensory therapy.
- Mental health therapy.
- Other functions (e.g., returning to work, driving).
- Guidelines include 2 management algorithms and 42 recommendations.
- Highlights of recommendations:
- Follow a team-based approach in an organized inpatient unit to improve patients’ likelihood of discharge to home.
- Start rehabilitation as soon as patients medically stable.
- Task-specific practice to improve outcomes such as extremity motor function, activities of daily living.
- Cardiovascular training to improve walking speed.
- Treat focal spasticity that is painful or limiting with botulinum toxin.
- Offer selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors and cognitive behavioral therapy to patients with poststroke depression.
- VA/DoD Evidence-Based Practice Work Group convened joint guideline development effort including clinical stakeholders, stroke survivors.
- Effort drew on a companion systematic review.
- Main outcome: guidelines intended to complement American Heart Association/American Stroke Association Guidelines for Adult Stroke Rehabilitation and Recovery.
- Funding: Department of Veterans Affairs.