Notice this is guidelines; NOT PROTOCOLS! so, they really don't know what they are doing to get you recovered. Isn't incompetence wonderful when your stroke medical 'professionals' have NO consequences from it, but it affects you!
Stroke Rehabilitation: Synopsis of the 2024 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines
Publication: Annals of Internal Medicine
Abstract
Description:
In
July 2024, the U.S. Department of Veterans Affairs (VA) and U.S.
Department of Defense (DOD) released a joint update of their 2019
clinical practice guideline (CPG) for the management(NOT RECOVERY!) of stroke
rehabilitation. This synopsis is a condensed version of the 2024 CPG,
highlighting the key aspects of the guideline development process and
describing the major recommendations.
Methods:
The
VA/DOD Evidence-Based Practice Work Group convened a joint VA/DOD
guideline development work group (WG) that included clinical
stakeholders and conformed to the Institute of Medicine’s tenets for
trustworthy CPGs. The guideline WG conducted a patient focus group,
developed key questions, and systematically searched and evaluated the
literature (English-language publications from 1 July 2018 to 2 May
2023). The GRADE (Grading of Recommendations Assessment, Development and
Evaluation) system was used to evaluate the evidence. The WG developed
47 recommendations along with algorithms for stroke rehabilitation in
the inpatient and outpatient settings. Stakeholders outside the WG
reviewed the CPG before approval by the VA/DOD Evidence-Based Practice
Work Group.
Recommendations:
This
synopsis summarizes where evidence is strongest to support guidelines
in crucial areas relevant to primary care physicians: transition to
community (case management, psychosocial or behavioral interventions);
motor therapy (task-specific practice, mirror therapy, rhythmic auditory
stimulation, electrical stimulation, botulinum toxin for spasticity);
dysphagia, aphasia, and cognition (chin tuck against resistance,
respiratory muscle strength training); and mental health (selective
serotonin reuptake inhibitor use, psychotherapy, mindfulness-based
therapies for treatment but not prevention of depression).
Stroke
is a major cause of morbidity, mortality, and disability worldwide. It
is a pervasive medical condition affecting nearly 800 000 persons
annually in the United States; approximately 75% of cases are first-time
occurrences and the remaining 25% are recurrent strokes (1). Roughly 3% of the U.S. population has experienced a stroke, with a projected increase to 4% by 2030 (1).
Stroke is the fifth most prevalent cause of death in the United States,
accounting for 1 out of every 21 deaths in the nation; alarmingly, a
stroke-related death occurs approximately every 3 minutes 17 seconds (1).
Stroke is a leading contributor to long-term disability, with
approximately 45% of persons aged 15 to 50 years having at least
moderate disability after a stroke (2).
The
spectrum of disability resulting from stroke manifests diversely.
Typical presentations may include motor weakness and sensory
disturbances, impairments in speech and swallowing, vision loss or
neglect, cognitive challenges involving inattention or memory loss, and
emotional difficulties, such as mood disorders or anxiety. Stroke
survivors consequently require tailored and timely rehabilitative
interventions aligning with their individualized needs (3, 4).
Tailored rehabilitative efforts should start as soon as clinically
feasible to maximize functional outcomes. These guidelines are relevant
for health care professionals across a stroke patient’s continuum of
care, including primary care providers, specialists (physiatry,
neurology, and cardiology), nurses, and allied health professionals.
The patient population of interest for the 2024 VA/DOD Clinical Practice Guideline for Management of Stroke Rehabilitation (5)
is adult patients with poststroke deficits (motor, cognitive, speech,
or sensory) who are candidates for rehabilitation. These guidelines can
be found at www.healthquality.va.gov/guidelines/rehab/stroke/index.asp.
The
focus and scope of the 2024 clinical practice guideline (CPG) is to
provide primary care providers in the U.S. Department of Veterans
Affairs (VA) and U.S. Department of Defense (DOD) with recommendations
and tools for the rehabilitation management of adult patients (aged ≥18
years) who have had a stroke, with an emphasis on an interdisciplinary
care approach. The guideline also provides stroke rehabilitation
specialist providers with guidelines for evidence-based practice. It is
intended to improve quality of care and clinical outcomes; however, it
is not intended to define a standard of care. The 2024 guideline is an
update to the 2019 VA/DOD Clinical Practice Guideline for Management of
Stroke Rehabilitation (6).
More at link.
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