Re: Rehabilitation after stroke: summary of NICE guidance
We, as I am sure many involved in the provision of specialist rehabilitation, are pleased that NICE considered that it was important to develop guidelines for the management of stroke patients . We are also reassured with the overarching position taken by the Guideline Development Group [GDG] that confirms that much of the evidence demonstrated that people improved in function and mobility from having an intervention, but there was little evidence to support one type of intervention over another .
However, despite the intentions of the GDG to facilitate innovations in practice  there is a significant risk that these guidelines  can be used by organisations and commissioners to restrict the practices of professionals by either enforcing certain treatment protocols or preventing others. There is anecdotal evidence from the membership of the Society for Rehabilitation in Research [SRR] that the clinician’s choice with respect to what can be offered in stroke rehabilitation will be significantly reduced as a result of this guideline.
Rehabilitation is a young, but rapidly growing, science. The innovations in rehabilitation research result from clinicians having the freedom to use their experiential learning to derive innovative treatments and experiments to elucidate the mechanisms underpinning treatment. In such circumstances the current wording associated with some of the recommendations within the guideline is likely to limit innovation and also be detrimental to patient care. There is also a significant risk that such restrictive recommendations may inadvertently interfere with the development of the rehabilitation science, particularly as the research priorities identified within these guidelines appear not to have cross-referenced some of the excellent work being done by professional organisations [e.g. 4] and the Stroke Research Network. The SRR is particularly concerned that there is an imminent risk that the research priorities in stroke rehabilitation is likely to be informed by these guidelines in isolation.
We acknowledge that the current stroke rehabilitation guideline is unlikely to change in the immediate future. However, given the large volume of high quality research currently being undertaken by SRR members it is likely that this guideline will need to be updated in the near future and we would hope that future GDG will utilise the expertise from a multidisciplinary professional organisations such as the SRR to inform this process.
1. Dworzynski K, Ritchie G, Fenu E, Mac Dermott K, Playford ED. Rehabilitation after stroke: summary of NICE guidance. BMJ 2013;346:f3615
2. Dworzynski K, Ritchie G, Fenu E, Mac Dermott K, Playford ED. Rehabilitation after stroke: summary of NICE guidance. BMJ 2013;346:f3615/rr/652112
3. 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
4. Pollock A , St George B, Fenton M, Firkins L. Top 10 research priorities relating to life after stroke - consensus from stroke survivors, caregivers, and health professionals. Int J Stroke. 2012 Dec 11. doi: 10.1111/j.1747-4949.2012.00942.x. [Epub ahead of print]
Competing interests: All authors are current members of the Society for Research in Rehabilitation council. ADP has the following additional competing interests to declare 1. Member International Functional Electrical Stimulation Society 2. Has received unrestricted educational support for rehabilitation related research from Allergan UK and Biometrics Ltd, UK. 3. Member of the Rehabilitation CSG in the Stroke Research Network