Notice how useless this is! 'Care'; NOT RECOVERY OR RESULTS!
Survivors don't want 'care', they want recovery; namely 100% recovery protocols!
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 HeartAssociation Council on Cardiovascular Nursing and the Stroke Council
I. Introduction
In the United States, the incidence rate of new or recurrentstroke is approximately 795 000 per year, and stroke preva-lence for individuals over the age of 20 years is estimated at6.5 million.
1
Mortality rates in the first 30 days after strokehave decreased because of advances in emergency medicineand acute stroke care. In addition, there is strong evidencethat organized postacute, inpatient stroke care deliveredwithin the first 4 weeks by an interdisciplinary healthcareteam results in an absolute reduction in the number of deaths.
2,3
Despite these positive achievements, stroke contin-ues to represent the leading cause of long-term disability inAmericans: An estimated 50 million stroke survivors world-wide currently cope with significant physical, cognitive, andemotional deficits, and 25% to 74% of these survivors requiresome assistance or are fully dependent on caregivers foractivities of daily living (ADLs).
4,5
Notwithstanding the substantial progress in acute strokecare over the past 15 years, the focus of stroke medicaladvances and healthcare resources has been on acute andsubacute recovery phases, which has resulted in substantialhealth disparities in later phases of stroke care. Additionally,healthcare providers (HCPs) are often unaware of not onlypatients’ potential for improvement during more chronicrecovery phases but also common issues that stroke survivorsand their caregivers experience. Furthermore, even withevidence that documents neuroplasticity potential regardlessof age and time after stroke,
6
the mean lifetime cost of ischemic stroke (which accounts for 87% of all strokes) inthe United States is an estimated $140 000 (for inpatient,rehabilitation, and follow-up costs), with 70% of first-yearstroke costs attributed to acute inpatient hospital care
1
;therefore, fewer financial resources appear to be dedicatedto providing optimal care during the later phases of strokerecovery.Because there remains a need to educate nursing and othermembers of the interdisciplinary team about the potential forrecovery in the later or more chronic phases of stroke care,the present scientific statement summarizes the best availableevidence and recommendations for interdisciplinary manage-ment of the needs of stroke survivors and their familiesduring inpatient and outpatient rehabilitation and in chroniccare and end-of-life settings. The guidelines for makingdecisions regarding classes and levels of evidence are listedin Table 1 and are the same as those used by previousAmerican Heart Association (AHA) writing groups.
7
Beforereviewing the evidence pertaining to stroke rehabilitation, wefirst briefly review the World Health Organization’s (WHO)international classification of functioning, disability, andhealth (ICF),
8
which serves as an organizational scaffold forthe present statement; provide an overview of the interdisci-plinary team approach to rehabilitation; and define the dif-ferent care settings in which stroke survivors may receiveservices during the more chronic phases of their recovery. Asa reference, a list of abbreviations used within this statementcan be found in Table 2.
I. Introduction
In the United States, the incidence rate of new or recurrentstroke is approximately 795 000 per year, and stroke preva-lence for individuals over the age of 20 years is estimated at6.5 million.
1
Mortality rates in the first 30 days after strokehave decreased because of advances in emergency medicineand acute stroke care. In addition, there is strong evidencethat organized postacute, inpatient stroke care deliveredwithin the first 4 weeks by an interdisciplinary healthcareteam results in an absolute reduction in the number of deaths.
2,3
Despite these positive achievements, stroke contin-ues to represent the leading cause of long-term disability inAmericans: An estimated 50 million stroke survivors world-wide currently cope with significant physical, cognitive, andemotional deficits, and 25% to 74% of these survivors requiresome assistance or are fully dependent on caregivers foractivities of daily living (ADLs).
4,5
Notwithstanding the substantial progress in acute strokecare over the past 15 years, the focus of stroke medicaladvances and healthcare resources has been on acute andsubacute recovery phases, which has resulted in substantialhealth disparities in later phases of stroke care. Additionally,healthcare providers (HCPs) are often unaware of not onlypatients’ potential for improvement during more chronicrecovery phases but also common issues that stroke survivorsand their caregivers experience. Furthermore, even withevidence that documents neuroplasticity potential regardlessof age and time after stroke,
6
the mean lifetime cost of ischemic stroke (which accounts for 87% of all strokes) inthe United States is an estimated $140 000 (for inpatient,rehabilitation, and follow-up costs), with 70% of first-yearstroke costs attributed to acute inpatient hospital care
1
;therefore, fewer financial resources appear to be dedicatedto providing optimal care during the later phases of strokerecovery.Because there remains a need to educate nursing and othermembers of the interdisciplinary team about the potential forrecovery in the later or more chronic phases of stroke care,the present scientific statement summarizes the best availableevidence and recommendations for interdisciplinary manage-ment of the needs of stroke survivors and their familiesduring inpatient and outpatient rehabilitation and in chroniccare and end-of-life settings. The guidelines for makingdecisions regarding classes and levels of evidence are listedin Table 1 and are the same as those used by previousAmerican Heart Association (AHA) writing groups.
7
Beforereviewing the evidence pertaining to stroke rehabilitation, wefirst briefly review the World Health Organization’s (WHO)international classification of functioning, disability, andhealth (ICF),
8
which serves as an organizational scaffold forthe present statement; provide an overview of the interdisci-plinary team approach to rehabilitation; and define the dif-ferent care settings in which stroke survivors may receiveservices during the more chronic phases of their recovery. Asa reference, a list of abbreviations used within this statementcan be found in Table 2.
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