Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient: A Scientific Statement From the American Heart Association

 So the wrong goals in stroke go back at least 14 years! 'Care' NOT RESULTS OR RECOVERY!

Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient: A Scientific Statement From the American Heart Association

Elaine L. Miller, PhD, RN, CRRN, FAHA, Chair; Laura Murray, PhD, CCC-SLP; Lorie Richards, PhD, OTR/L, OT, FAHA; Richard D. Zorowitz, MD, FAHA; Tamilyn Bakas, PhD, RN, FAHA; Patricia Clark, PhD, RN, FAHA; Sandra A. Billinger, PhD, PT, FAHA; on behalf of the American Heart Association Council on Cardiovascular Nursing and the Stroke Council I. 

2010, Stroke

 

Introduction  

 

In the United States, the incidence rate of new or recurrent stroke is approximately 795 000 per year, and stroke prevalence for individuals over the age of 20 years is estimated at 6.5 million. ¹ Mortality rates in the first 30 days after stroke have decreased because of advances in emergency medicine and acute stroke care. In addition, there is strong evidence that organized postacute, inpatient stroke care delivered within the first 4 weeks by an interdisciplinary healthcare team results in an absolute reduction in the number of deaths. ^2,3 Despite these positive achievements, stroke continues to represent the leading cause of long-term disability in Americans: An estimated 50 million stroke survivors worldwide currently cope with significant physical, cognitive, and emotional deficits, and 25% to 74% of these survivors require some assistance or are fully dependent on caregivers for activities of daily living (ADLs). ^4,5 Notwithstanding the substantial progress(I see NO progress anywhere in stroke. Everything is a complete failure! No one is working on 100% recovery!) in acute stroke care over the past 15 years, the focus of stroke medical advances and healthcare resources has been on acute and subacute recovery phases, which has resulted in substantial health disparities in later phases of stroke care. Additionally, healthcare providers (HCPs) are often unaware of not only patients’ potential for improvement during more chronic recovery phases but also common issues that stroke survivors and their caregivers experience. Furthermore, even with evidence that documents neuroplasticity potential regardless of age and time after stroke, ⁶ the mean lifetime cost of ischemic stroke (which accounts for 87% of all strokes) in the United States is an estimated $140 000 (for inpatient, rehabilitation, and follow-up costs), with 70% of first-year stroke costs attributed to acute inpatient hospital care ¹ ; therefore, fewer financial resources appear to be dedicated to providing optimal care during the later phases of stroke recovery. Because there remains a need to educate nursing and other members of the interdisciplinary team about the potential for recovery in the later or more chronic phases of stroke care, the present scientific statement summarizes the best available evidence and recommendations for interdisciplinary management of the needs of stroke survivors and their families during inpatient and outpatient rehabilitation and in chronic care and end-of-life settings. The guidelines for making decisions regarding classes and levels of evidence are listed in Table 1 and are the same as those used by previous American Heart Association (AHA) writing groups. ⁷ Before reviewing the evidence pertaining to stroke rehabilitation, we first briefly review the World Health Organization’s (WHO) international classification of functioning, disability, and health (ICF), ⁸ which serves as an organizational scaffold for the present statement; provide an overview of the interdisciplinary team approach to rehabilitation; and define the different care settings in which stroke survivors may receive services during the more chronic phases of their recovery. As a reference, a list of abbreviations used within this statement can be found in Table 2.