Practice Guidelines

Rehabilitation after stroke: summary of NICE guidance

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3615 (Published 12 June 2013) Cite this as: BMJ 2013;346:f3615
  1. Katharina Dworzynski, senior research fellow1,
  2. Gill Ritchie, guideline lead1,
  3. Elisabetta Fenu, health economist lead1,
  4. Keith MacDermott, GP guideline development group member2,
  5. E Diane Playford, guideline chair3
  6. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians of London, London NW1 4LE, UK
  2. 29 Kilburn Road, York YO10 4DF, UK
  3. 3UCL Institute of Neurology, London WC1N 1PJ, UK
  1. Correspondence to: K Dworzynski Katharina.Dworzynski{at}rcplondon.ac.uk

Each year, about 150 000 people in the UK have a first or recurrent stroke.1 Despite UK health policies that place a great emphasis on reducing stroke (such as the National Stroke Strategy2) and improvements in mortality and morbidity, guidance is needed on access to and provision of effective rehabilitation services to maximise quality of life after stroke. This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on long term rehabilitation after stroke.3

Recommendations

NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations can be based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Organising rehabilitation and care for people with stroke

Rehabilitation may take place in a variety of settings—in hospital, in outpatient clinics, in the community, and in individuals’ own homes.

  • People with disability after stroke should receive rehabilitation in a dedicated stroke inpatient unit and subsequently from a specialist stroke team within the community. [Based on modified Delphi consensus statements]

  • The core stroke rehabilitation team should comprise the following professionals with expertise in stroke rehabilitation: consultant physician, nurse, physiotherapist, occupational therapist, speech and language therapist, clinical psychologist, rehabilitation assistant, and social worker. [Based on modified Delphi consensus statements]

  • Offer early supported discharge to people with stroke who are able to transfer from bed to chair independently or with assistance if a safe and secure environment can be provided. [Based on high to very low quality evidence from randomised controlled trials]

Planning and delivering stroke rehabilitation

To ensure the safety of the person with stroke while maintaining a patient centred approach, key processes need to be in place. These processes include assessment on admission …

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