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Date:  May 24, 1995
Contact: AHCPR Public Affairs (301) 594-1364
             Bob Griffin, ext. 169
             Paula Zeller, ext. 148

Rehabilitation programs vary widely, the guideline advises, so knowledge about what a particular nursing home, hospital or other facility offers is essential.

Evaluations to determine what rehabilitation program a patient needs should use standardized tests, the guideline says, and should be conducted by someone experienced in stroke rehabilitation.

Stroke is the leading cause of disability in adults -- costing Medicare, insurance carriers and individuals $33 billion a year from acute care through rehabilitation. The direct cost for stroke rehabilitation alone is $7.6 billion.

"The guideline -- the first of its kind -- offers the hope of higher-quality, more independent lives for many of the 3 million Americans who have varying degrees of disability from stroke," said AHCPR Administrator Clifton R. Gaus, Sc.D.

Rehabilitation treatment programs can be very demanding on stroke survivors, their families and caregivers as they work to adjust to the stroke's impact on their daily lives, said Gaus. "People need to know what to expect from rehabilitation, and this guideline and the accompanying consumer guide provide that information," he said.

Since the effects of stroke can be as wide-ranging as the settings in which rehabilitation takes place, making the right match between stroke survivors' needs and the appropriate rehabilitation services is a challenge. Failure to find the right "fit" can result in either too little or too much care for a patient's individual needs.

"The guideline makes specific recommendations for proper evaluation of stroke survivors, matching of their needs to the most appropriate rehabilitation services and careful coordination in delivering these services," said Douglas B. Kamerow, M.D., M.P.H., director of the AHCPR center that coordinates the development of clinical practice guidelines. "Widespread adoption of the guideline should increase the cost-effectiveness and value of rehabilitation by promoting more uniform and appropriate services for evaluation and care."

Stroke is the leading cause of disability in adults in the United States. Stroke survivors may need help learning how to walk again, or talk.

Almost 75 percent of all strokes occur in people 65 years of age or older. Rates of stroke are 50 percent higher in African-American men than in white men and 130 percent higher in African-American women than in white women.

"Unless stroke survivors are properly evaluated and then correctly matched with the services they need, their rehabilitation may lead to less than optimal results," said Glen E. Gresham, M.D., director of rehabilitation medicine for the State University of New York at Buffalo, and chair of the 18-member panel of experts and a consumer that developed the guideline.

Good matching, Gresham said, is the result of good evaluation. "The guideline offers health care providers a list of standardized assessment tools -- for example, measures of neurological deficits, mental status, and motor function and balance -- that can be used across the board to evaluate a stroke survivor's medical, psychological and neurological condition," he said.

The guideline also gives specific criteria from these tools to help determine admittance to different kinds and levels of rehabilitation programs. "Practitioners who refer stroke survivors for rehabilitation must be familiar with local rehabilitation services and their capabilities," said Gresham. "Otherwise, people may get sent to a place that does not best suit their needs."

Because rehabilitation usually requires a number of different rehabilitation professionals to work with the stroke survivor, the guideline recommends that one member of the rehabilitation team be the designated coordinator of services who establishes a baseline evaluation and keeps consistent records of the survivor's progress throughout rehabilitation. Progress should be monitored weekly during intense inpatient rehabilitation and at least every two weeks during less intense programs. The guideline recommends regular evaluation to obtain the information required to adjust treatment regimens and also to justify continued rehabilitation; it also recommends that treatment regimens be automatically reviewed if they fail to show progress on two successive evaluations.

The survivor's primary care provider should be the coordinator of continuing medical needs during the transition to life back within the community, according to the guideline.

Pamela W. Duncan, Ph.D., P.T., director of research at Kansas University Medical Center's Center on Aging and co-chair of the guideline panel, said the consumer guide written by AHCPR for stroke survivors, their families and caregivers describes what consumers should know about stroke, caring for the survivor at home and stroke rehabilitation services. For example, the brochure includes tips to help survivors and those who care for them ease the stresses of adjusting to life after a stroke.

"This guide shows how stroke survivors, their families and/or caregivers can work together with rehabilitation professionals to get the best possible results," said Duncan. "The guide also tells them what to look for in stroke rehabilitation services and what to ask when evaluating a particular program. For example, does the program actively involve the patient and family members in rehabilitation decisions?"

AHCPR is disseminating the consumer booklet -- which is available in both English and Spanish -- to senior citizen groups, hospitals, home health agencies, nursing homes and other organizations, along with the guideline.

Post-Stroke Rehabilitation: Quick Reference Guide for Clinicians and Recovering After a Stroke (intended for stroke survivors, their families and caregivers) are available free of charge from the AHCPR Publications Clearinghouse. Call toll-free 800/358-9295, or write Post-Stroke Rehabilitation Guideline, AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, Md. 20907. The clearinghouse also has available the AHCPR-sponsored guideline publications on depression, urinary incontinence and pressure sores that are recommended in the post-stroke guideline.

The quick reference and consumer versions of the guideline, as well as other free AHCPR publications, also are available 24 hours a day through AHCPR InstantFAX, 301/594-2800.

The guideline products will be available on Internet and can be accessed by using a Web browser and specifying URL text.nlm.nih.gov. For other online options, request Online Access for Clinical Practice Guidelines, AHCPR publication no. 94-0075, by calling AHCPR InstantFAX or the AHCPR clearinghouse.

The full guideline -- Post-Stroke Rehabilitation: Clinical Practice Guideline -- may be purchased from the U.S. Government Printing Office by calling 202/512-1800.