Post-acute care and secondary prevention after ischaemic stroke

In the first part of this two part review (BMJ 2011;342:d1938) we discussed acute diagnosis and management of cerebrovascular events. Much of the focus of recent research, public health initiatives, and health policy has been around acute and hyperacute management of stroke. However, important goals of stroke care are to maximise functional recovery and prevent recurrent events. Here we draw on evidence from randomised trials and meta-analyses to discuss models of care, rehabilitation, and secondary prevention in stroke.

An important aspect of post-acute stroke care is rehabilitation. Rehabilitation research remains a “young” science, although an evidence base is emerging. As we make progress in this field, we need a common language to describe this important intervention. In the box we offer our own definition of stroke rehabilitation, although others may offer differing suggestions. Many questions remain unanswered regarding timing, optimal components, and frequency and intensity of rehabilitation. Further discussion of rehabilitation as a concept or rehabilitation theory specific to stroke is beyond the scope of this article, but recent high quality publications on the subject are available.^{w1 …}