The levels of evidence supporting the recommendations (I-IV) and clinical practice points (CPP) are defined at the end of the "Major Recommendations" field.
Stroke Unit Care
All people admitted to hospital with stroke and who require rehabilitation should be treated in a comprehensive or rehabilitation stroke unit with an interdisciplinary team. (Level I, [Stroke Unit Trialists Collaboration, 2001])
If no stroke unit is available, consideration should be given to transferring the person with stroke (when medically stable) to the nearest stroke unit, or a hospital that most closely meets the criteria for stroke unit care. (CPP)
Inpatient Integrated Care Pathways
There is insufficient evidence to support recommendations about routine use of care pathways. If used, care pathways should be flexible enough to meet the heterogeneous needs of people with stroke. (CPP)
Inpatient Stroke Care Coordinator
A stroke coordinator may be used to foster coordination of services and assist in discharge planning. (CPP)
Early Supported Discharge
Where comprehensive interdisciplinary community rehabilitation services and carer support services are available, early supported discharge services may be provided for people with mild to moderate disability. (Level I, [Langhorne et al., 2005; Teasell et al., 2003; Anderson et al., 2002; Early Supported Discharge Trialists, 2002])
Community Rehabilitation
Rehabilitation for people with stroke in the community is equally effective if delivered in the hospital via outpatients or day hospital, or in the community. (Level I, [Outpatient Service Trialists, 2002; Britton & Andersson, 2000; Forster, Young, & Langhorne, 1999])
Discharge Destination
Decisions about discharge destination (home versus residential care) should be made in the context of availability of supportive services and the wishes of the stroke survivor and carer. (CPP)
Respite Care
People with stroke and their carers should have access to respite care. This may be provided in their own home or an institution. (CPP)
Ongoing Review
People with stroke should have regular and ongoing review by a member of a stroke team, including at least one specialist medical review following discharge. (CPP)
Definitions:
Levels of Evidence
| I |
Evidence obtained from a systematic review of all relevant randomised controlled trials. |
| II |
Evidence obtained from at least one properly designed randomised controlled trial. |
| III-1 |
Evidence obtained from well-designed pseudo-randomised controlled trials (alternate allocation or some other method). |
| III-2 |
Evidence obtained from comparative studies with concurrent controls and allocation randomised (cohort studies), case-control studies, or interrupted time-series with group. |
| III-3 |
Evidence obtained from comparative studies with historical control, two or more studies, or interrupted time series without a parallel control group. |
| IV |
Evidence obtained from case series, either post-test or pre-test and post-test. |
Clinical Practice Points
| CPP |
Recommended best practise based on clinical experience and expert opinion. |
