Stroke rehabilitation in adults: summary of updated NICE guidance

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 Stroke rehabilitation in adults: summary of updated NICE guidance

BMJ 2024; 384 doi: https://doi.org/10.1136/bmj.q498 (Published 22 March 2024) Cite this as: BMJ 2024;384:q498

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1. Eugene Tang, NIHR clinical lecturer in general practice1,   
2. Nicola Moran, stroke physiotherapist2,   
3. Mark Cadman, lay member3 4,   
4. Stephen Hill, lay member3 4,   
5. Claire Sloan, health economist3,   
6. Elizabeth Warburton, consultant stroke physician3 5
7. on behalf of the guideline committee

Author affiliations

1. Correspondence to E Tang (eugene.tang@newcastle.ac.uk)

What you need to know

• Stroke rehabilitation total therapy time should be based on the person’s needs, with the amount increasing to at least three hours a day on at least five days a week

• Fatigue is common; use a validated scale for early assessment

• Offer vision and hearing assessment

• Consider referral to community participation programmes suited to the person’s rehabilitation goals

Introduction

Globally, stroke is the second leading cause of death and the third leading cause of death and disability combined.1 Around 100 000 people have strokes each year, and around 1.3 million people in the UK have survived a stroke.2 High quality rehabilitation can minimise the physical, emotional, cognitive, and social impacts for people who have had a stroke and their carers, and yield substantial cost savings to society.3

The National Institute for Health and Care Excellence (NICE) first published guidance on stroke rehabilitation in adults in 2013.4 The guidance was updated in October 2023 to include appraisal of new evidence.5 This guideline summary covers selected new and updated recommendations in the 2023 update, and will focus on those most relevant to primary care and community rehabilitation settings.

Recommendations

NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline development group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italics in square brackets. Evidence certainty is based on GRADE criteria (box 1).

Box 1

GRADE Working Group grades of evidence

• High certainty—we are very confident that the true effect lies close to that of the estimate of the effect.

• Moderate certainty—we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

• Low certainty—our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.

• Very low certainty—we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.