Practice Guidelines

Rehabilitation of patients with stroke: summary of SIGN guidance

BMJ 2010; 340 doi: (Published 15 June 2010) Cite this as: BMJ 2010;340:c2845
  1. Lorraine N Smith, professor of nursing1,
  2. Roberta James, programme manager2,
  3. Mark Barber, lead clinician, stroke managed clinical network3,
  4. Scott Ramsay, consultant physician and geriatrician, lead clinician for stroke4,
  5. David Gillespie, consultant clinical neuropsychologist5,
  6. Charlie Chung, clinical specialist occupational therapist (stroke)6
  7. on behalf of the Guideline Development Group
  1. 1Nursing and Health Care, Faculty of Medicine, University of Glasgow, Glasgow G12 8LL
  2. 2Scottish Intercollegiate Guidelines Network (SIGN), Edinburgh EH7 5EA
  3. 3Department of Medicine for the Elderly, Monklands Hospital, Airdrie ML6 0JS
  4. 4St John’s Hospital, Livingston EH54 6PP
  5. 5Department of Clinical Psychology, Astley Ainslie Hospital, Edinburgh EH9 2HL
  6. 6Stroke Unit, Victoria Hospital, Fife KY2 5AH
  1. Correspondence to: L N Smith l.n.smith{at}

    Stroke is the third most common cause of death and the most frequent cause of severe adult disability in Scotland.1 Despite considerable advances in organised stroke care over recent years, improvements are still needed,2 because patients have been reported to spend up to 50% of their time in bed3 and only 20% of their time in treatment.4 Since publication of the previous Scottish Intercollegiate Guidelines Network (SIGN) guideline on rehabilitation after stroke (SIGN 64), several small studies have shown the effectiveness of new therapeutic techniques and technologies.5 This guideline supersedes the earlier guideline and summarises the most recent recommendations from SIGN on rehabilitation after stroke.6 It also complements SIGN guidelines 119 and 108 on other aspects of the management of stroke.7 8


    SIGN recommendations are based on systematic reviews of best available evidence. The strength of the evidence is graded as A, B, C, or D (figure), but the grading does not reflect the clinical importance of the recommendations. Recommended best practice (“good practice points”), based on the clinical experience of the guideline development group, is also indicated (as GPP).

    Explanation of SIGN grades of recommendations

    Arranging appropriate care

    • Admit stroke patients who require admission to hospital to a stroke unit staffed by a coordinated multidisciplinary team with a special interest in stroke care (A).

    • In exceptional circumstances, when admission to a stroke unit is not possible, provide rehabilitation in a generic rehabilitation ward on an individual basis (B).

    • The core multidisciplinary team should include appropriate levels of nursing, medical, physiotherapy, occupational therapy, speech and language therapy, and social work staff (B).

    • Stroke inpatients should be treated 24 hours a day by nurses who specialise in stroke and are based in a stroke unit (B).

    • Actively involve patients and carers early in the rehabilitation process …

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