Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Rehabilitation after stroke: summary of NICE guidance

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3615 (Published 12 June 2013) Cite this as: BMJ 2013;346:f3615

Rapid Response:

Re: Rehabilitation after stroke: summary of NICE guidance

Dear Sir,

We should like to highlight some important areas following the publication summary of the recent NICE Stroke Rehabilitation Guidelines (1). We agree with Drummond et al (2) that much of the evidence cited has been labelled as low evidence despite the high level of evidence that is actually available.

The aspects of visual impairments due to stroke fall into the category of being relegated as poorly evidenced. Unfortunately the guidelines did not refer to the range of Cochrane systematic reviews relating to eye conditions and restricted its studies to those only involving stroke patients. In eye care, many rehabilitation options are targeted at the eye condition itself and reports of treatment efficacy are not restricted to the various causative conditions with stroke being just one cause. Thus, considerable evidence was not reported. We also question the modified Delphi analysis which, for visual impairment, failed to include a wide, expert sample from the eye care professions. As a result we query these results.

Yet again there has been a failure to recognise the importance of vision and the impact of visual impairment on stroke survivors.

Mrs Lesley-Anne Baxter, Chair: British and Irish Orthoptic Society
Mrs Claire Howard, Stroke Specialist Interest Group Lead: British and Irish Orthoptic Society
Dr Fiona Rowe, Research Lead: British and Irish Orthoptic Society

References
1. Dworzynski K, Ritchie G, Fenu E, Mac Dermott K, Playford ED. Rehabilitation after stroke: summary of NICE guidance. BMJ 2013;346:f3615
2. Drummond A, Walker M, Wade D, Tyrrell P, Lincoln N, Langhorne P, Sandercock P. Rehabilitation after stroke: summary of NICE guidance. BMJ 2013;346:f3615/rr/650771

Competing interests: FR: Co-opted on NICE Stroke Rehabilitation GDG - 2012

27 June 2013
Fiona J Rowe
Research Lead for Orthoptics
Lesley-Anne Baxter, Claire Howard
British and Irish Orthoptic Society
62 Wilson Street, London EC2A 2BU