Despite significant investment starting over a decade ago (2000) in evidence based reviews, best practice guidelines, standards of care, and centralized data collection—critical outcomes for stroke patients have not improved. Only about 6% of the stroke budgets were spent on rehab and community care.
- There is strong evidence that rehabilitation needs to be intensive and functional, yet many rehabilitation patients continue to receive minimal practice. In fact many stroke survivors in rehabilitation spend the majority of their time alone and resting.
- Pressure to move people through the rehabilitation system has resulted rehabilitation centres accepting patients with much milder impairments. This is measured by rising admission FIMtm scores. Severe stroke patients often cannot access the stroke rehabilitation system.
- Maintenance care is declining or nonexistent. Families and stroke survivors are not supported once after discharge from hospital.
The authors charge that the stroke rehabilitation system continues to function according to traditional ways of practicing rather than introducing new evidence-based modes of treatment.
Read more:
- Stroke Rehabilitation in Canada: A Work in Progress
- Dr. Teasell’s Evidence Based Stroke Rehabilitation Powerpoint
CMAJ April 20, 2010 vol. 182 no. 7: Read what providers in the stroke system have to say:
- “The ideal is for patients to receive rehabilitation three hours per day, seven days a week”
- “We’ve been good at providing housing and meals but we’ve got further to go in terms of getting our patients up and moving and engaged. “
- We don’t give our patients enough therapy.”
Are mild stroke survivors getting the support they need?
In mild stroke, people are often discharged without further support or rehabilitation. The assumption is that they will recover fully with the support of their family and friends.
In a study done in Calgary, while biophysical measures revealed consistent improvement, psychosocial measures did not.
Mild stroke survivors were distressed by their inability to function in their normal capacity. Typically, fatigue and endurance, not actual motor weakness that hindered their recovery and full reintegration into family, community and work roles.
Are families getting the support they need?
The support of family members acts as a key facilitator of stroke recovery. Having a person in the home, prepared to care, is a major reason why stroke survivors can return home. Stroke survivors without someone at home are at higher risk for being admitted to a nursing home. Studies have identified 6 main areas of need associated with family’s caring role:
- Need for information;
- High prevalence of stress, strain and depression;
- Taking on new responsibilities;
- Limited time for leisure and social activity contributing to isolation;
- Difficulty balancing one’s own needs compared with the person who has had a stroke; and
- Financial repercussions.
Best practice guidelines in the United Kingdom, United States, and Canada all recommend support for families.
Annie Rochette defines best practice for families post-stroke, “as a clinician identifying a potential family-related problem when one exists, utilizing one or more of the standardized assessments related to family functioning or burden, and providing a family related intervention.”
So how do Canadian physiotherapists, speech language therapists, and occupational therapists do in identifying family’s need for support?
Rochette and colleagues surveyed 1755 therapists to find out.
While therapists can identify family problems and offer interventions--
0nly 12/ 1755 indicated they use any standardized assessment of family functioning
- One-third of the sample identified a family-related problem and offered a related intervention, but only 12/1755 clinicians indicated that they would typically use a standardized assessment of family functioning.
Occupational therapists are best at identifying family problems--
- Being a PT (OR 0.53) or an SLP (OR 0.49) vs an OT was negatively associated with being a problem identifier, whereas being older (OR 1.02 ) or working in Ontario (OR 1.58) was associated with being a problem identifier.
Rochette’s Conclusion: For these 3 disciplines, the prevalence of a family- related focus is low post-stroke. Given the increasing evidence regarding the effectiveness of family-related interventions on stroke outcomes, it is imperative that best practice is implemented.
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