The levels of evidence supporting the recommendations (I-IV) and clinical practice points (CPP) are defined at the end of the "Major Recommendations" field.
Activity and Participation in the Community
Self-management
People with stroke who do not have cognitive impairment should be made aware of the availability of generic self-management programs before discharge from hospital and be supported to access such programs once they have returned to the community. (Level II, [Lorig et al., 2001; Lorig et al., 1999; Fu et al., 2003])
Stroke-specific programs for self-management may be provided to people who require more specialised programs. (CPP)
A collaboratively developed self-management care plan may be used to harness and optimise self-management skills. (CPP)
Activities of Daily Living (ADL) and Exercise
People living in the community who have difficulties with ADL should have access, as appropriate, to therapy services to improve, or prevent deterioration in, ADL. (Level I, [Outpatient Service Trialists, 2002])
People who are living in the community more than 6 months after their stroke should have access to interventions to improve fitness and mobility. (Level II, [Ouellette et al., 2004; Chu et al., 2004; Ada et al., 2003])
People living in the community should be provided with information (e.g., alternative transport options, resuming driving, ADL and exercise opportunities/services) to facilitate increased outdoor journeys and therefore greater participation within the community. The information provided should also be supplemented by other simple strategies (e.g., encouragement, use of appropriate aids/appliances, approaches to overcoming fear) by an appropriate health professional. (Level II, [Logan et al., 2004])
General practitioners should refer to allied health professionals where necessary when undertaking routine medical review of people with stroke. (CPP)
Driving
People with stroke who wish to return to driving may be offered a visual attention retraining program or traditional perceptual training. (Level II, [Mazer et al., 2003])
The National Guidelines for Driving (Austroads) and relevant state guidelines should be followed for all issues relating to driving following a stroke. (CPP)
People with stroke who wish to return to driving should be offered an opportunity to undertake an occupational therapy driving assessment, unless there are medical contraindications. (CPP)
Leisure
Targeted occupational therapy may be used to increase participation in leisure activities. (Level I, [Walker et al., 2004])
Return to Work
People with stroke who wish to work should be offered assessment and assistance to resume or take up work. (CPP)
Sexuality
People with stroke and their carers should be offered:
- The opportunity to discuss issues relating to sexuality with an appropriate health professional; (CPP)
- Written information addressing issues relating to sexuality post-stroke. (CPP)
Any interventions should address psychosocial aspects as well as physical function. (CPP)
Support
Peer Support
Stroke survivors should be provided with information about the availability and potential benefits of a local stroke support group and/or other sources of peer support prior to discharge from the hospital. (CPP)
Counselling
Counselling services should be made available to all stroke survivors and their families and may take the form of:
- An active educational counselling approach; (Level I, [Bhogal et al., 2003])
- Information supplemented by family counselling; (Level II, [Clark, Rubenach, & Winsor, 2003])
- A problem-solving counselling approach. (Level II, [Evans et al., 1988])
Carer Support
Carers of stroke survivors should be provided with:
- Information about the availability and potential benefits of local stroke support groups, at or before the person's return to the community; (Level II, [van den Heuvel et al., 2002]; Level III-2, [van den Heuvel et al., 2000])
- Support by health professionals starting early after the person's stroke. (CPP)
Carers of stroke survivors should be offered services to support them after the person's return to the community. Such services should use a problem-solving or educational-counselling approach. (Level II, [van den Heuvel et al., 2002; Hartke & King, 2003; Grant, 1999]; Level III-2, [van den Heuvel et al., 2000])
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. |
