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

Whilst fully endorsing the concerns expressed by others [1,2] about the methodological shortcomings of the NICE guideline development itself, I wish to respond to the NICE research priorities [3]. One of these is ‘Which cognitive and emotional interventions provide better outcomes for identified subgroups of people with stroke and their families and carers at different stages of the stroke pathway?’

I strongly support the importance of this question, albeit many different questions all rolled into one that will need careful teasing apart. As co-author of several Cochrane reviews of post-stroke cognitive rehabilitation I am all too aware of the absence of robust research evidence for effective interventions for cognition and emotion. Recently the James Lind Alliance identified ‘ways to improve cognition after stroke’ as the number 1 shared research priority for survivors, carers and health professionals [4]. Another two of the top 10 priorities were around ‘helping people come to terms with long term consequences’ and ‘ways to improve confidence’. Additionally, when stroke survivors were asked about their longer term unmet needs for health problems in a Stroke Association survey [5], cognitive problems such as memory and concentration were reported as the highest unmet needs (Table 3, 59%, 43% respectively, weighted).

The recent NIHR HTA’s commissioning brief on research into depression post-stroke is an encouraging first step to improve one aspect of psychological well-being after stroke. However, there is insufficient research coming through on the UKCRN portfolio especially with regard to cognitive rehabilitation. One positive outcome from the NICE guideline would be if it influenced serious research investment aimed at improving psychological well-being for survivors and carers. What steps can and will NICE take to achieve this?

1. http://www.bmj.com/content/346/bmj.f3615/rr/652847

2. http://www.bmj.com/content/346/bmj.f3615/rr/652772

3.
http://www.bmj.com/content/346/bmj.f3615

4. http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(12)70029-7/fulltext

5. http://stroke.ahajournals.org/content/42/5/1398

Competing interests: My university role includes applying for funding for research to improve stroke services. I represent the British Psychological Society on the Intercollegiate Stroke Working Party and contributed to the ICSWP's Stroke Guideline.

08 July 2013
Audrey Bowen
Senior lecturer in psychology
University of Manchester
Vascular and Stroke Research, CSB, Salford Royal NHS Foundation Trust, Stott Lane, M68HD