Deans' stroke musings: National Institute for Health and Care Excellence stroke rehabilitation guidance – is it useful, usable, and based on best evidence?

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, May 29, 2014

National Institute for Health and Care Excellence stroke rehabilitation guidance – is it useful, usable, and based on best evidence?

This is a simple question to answer. What are the results? How many patients get to 100% recovery? The answer to that will tell you if this is a failure or not. In the US statistics tell us that only 10% get to full recovery. Complete failure in any endeavor. Even if this is based on best evidence everyone associated with this needs to be fired.
http://cre.sagepub.com/content/28/6/523.abstract

¹University of Nottingham, Nottingham, UK
²Nuffield Orthopaedic Centre, Oxford, UK

Avril Drummond, University of Nottingham, A Floor, South Block, Queen’s Medical Centre (QMC), Nottingham NG7 2HA, UK. Email: avril.drummond@nottingham.ac.uk

Abstract

In the UK, the National Institute for Health and Care Excellence (NICE) is responsible for producing clinical guidance based on sound evidence. In 2013 they produced guidance on Stroke Rehabilitation and this editorial outlines why this is not a useful guide for clinicians or commissioners. Primarily this is because NICE used inappropriate methods; the methods used are appropriate for evaluating drugs, but are inappropriate when applied to any complex intervention. Moreover, the actual recommendations are written in clinically unhelpful language.

Future rehabilitation guidance should include ensuring that the team responsible for the guidance are all familiar with and understand the biospsychosocial model of illness and the nature of the rehabilitation process (which is not synonymous with therapy), setting a relevant and appropriate scope for a guideline, agreeing to use all evidence relevant to a particular question, and using a more appropriate way to evaluate evidence while recognising that rehabilitation is a complex intervention.(This is accepting failure as ok, call your doctor out that that mindset will not be tolerated).