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

1. Avril Drummond1
2. Derick T Wade2

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

1. 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).