Summary of Stroke Best Practice Recommendations

1 CANADIAN best Practice Recommendations FOR Stroke CARE Fourth Edition Lindsay MP, Gubitz G, Bayley M, Phillips S (Editors), on Behalf of the Canadian Stroke best practices and Standards Working Group Summary of Stroke best Practice Recommendations 2012 2013 Update Canadian best Practice Recommendations for Stroke Care Table of Contents Update 2012 - 2013 Fourth Edition November 2013 Page 2 of 81 Table of Contents Overview .. 4 Section Awareness of Stroke .. 6 Section Prevention of Stroke .. 7 Lifestyle and Risk Factor Management .. 7 Blood Pressure Management .. 8 Lipid Management.

2 9 Diabetes Management .. 10 Antiplatelet Therapy .. 10 Antithrombotic Therapy in Patients with Atrial Fibrillation .. 11 Management of Extracranial Carotid Disease and Intracranial Atherosclerosis .. 14 Assessment and Management of Obstructive Sleep Apnea .. 15 Management of Smoking Cessation .. 17 Section Hyperacute Stroke Management .. 18 Outpatient Management of Transient Ischemic Attack and Non-Disabling Ischemic Stroke .. 18 Emergency Medical Services Management of Acute Stroke Patients .. 20 Emergency Department Evaluation and Management of Patients with Transient Ischemic Attack and Acute Stroke .. 23 Acute Thrombolytic Therapy.

3 27 Acute Aspirin Therapy .. 29 Early Management of Acute Subarachnoid Hemorrhage .. 29 Early Management of Intracerebral Hemorrhage .. 31 Early Management of Patients Considered for Hemicraniectory .. 34 Section Acute Inpatient Stroke Management .. 36 Stroke Unit Care .. 36 Inpatient Management and Prevention of Complications Following Acute Stroke or TIA .. 37 Palliative and End-of-Life Care .. 41 Advanced Care Planning .. 42 Section Rehabilitation .. 43 Initial Stroke Rehabilitation Assessment .. 43 Stroke Rehabilitation Unit Care .. 44 Delivery of Inpatient Stroke Rehabilitation .. 45_Toc371600486 Outpatient and Community-Based Stroke Rehabilitation (including Early Supported Discharge).

4 46 Management of the Arm and Hand following Stroke .. 47 Range of Motion and Spasticity in the Shoulder, Arm and Hand .. 49 Canadian best Practice Recommendations for Stroke Care Table of Contents Update 2012 - 2013 Fourth Edition November 2013 Page 3 of 81 Management of Shoulder Pain following Stroke .. 49 Lower Limb Mobility and Transfer Skills .. 51 Lower Limb Spasticity Following Stroke .. 52 Lower-Limb Gait Training following Stroke .. 52 Falls Prevention and Management .. 52 Assessment and Management of Dysphagia and Malnutrition Following Stroke .. 53 Rehabilitation of Visual Perceptual Deficits .. 54 Rehabilitation to Improve Central Pain.

5 55 Rehabilitation to Improve Communication .. 55 Life Roles and Activities (Driving, Vocation, Sexuality and Relationships, and Leisure) .. 56 Section Managing Stroke Transitions of Care .. 58 Supporting Patients, Families and Informal Caregivers Following Stroke .. 58 Patient, Family and Informal Caregiver Education .. 60 Interprofessional Communication .. 63 Discharge Planning .. 64 Community Reintegration Following Stroke .. 65 Transition of Patients to Long-Term Care Following a Stroke .. 69 Post- Stroke Fatigue .. 71 Section Mood and Cognition in Stroke .. 73 Identification and Management of Post- Stroke Depression (PSD).

6 73 Vascular Cognitive Impairment and Dementia .. 76 Section Delivery of Stroke Care Using Telestroke Technology .. 79 Delivery of Stroke Care Using Telestroke Technology .. 79 Canadian best Practice Recommendations for Stroke Care Overview Update 2012-2013 Fourth Edition FINAL Master Stroke Recommendation List Page 4 of 81 OVERVIEW CANADIAN best Practice Recommendations FOR Stroke CARE The Canadian best Practice Recommendations for Stroke Care are intended to provide up-to-date evidence-based guidelines for the prevention and management of Stroke . The goal of disseminating and implementing these Recommendations is to reduce Practice variations in the care of Stroke patients across Canada, and to reduce the gap between knowledge and Practice .

7 Recommendations are updated every two years to ensure they continue to reflect contemporary Stroke research evidence and leading expert opinion. Each update involves critical review of the current medical literature, which informs decisions regarding modification of the Recommendations and the performance measures used to assess their impact. Every attempt is made to coordinate with other Canadian groups who are developing guidelines that relate to Stroke , such as hypertension, atrial fibrillation and diabetes. This is the fourth edition of the Canadian best Practice Recommendations for Stroke Care, which was first released in 2006.

8 The theme of the 2012 2013 update is TAKING ACTION, and stresses the critical role and responsibility of healthcare providers at every stage of the continuum of care to ensure that best Practice Recommendations are implemented and adhered to. TAKING ACTION will lead to optimal outcomes for each Stroke patient by providing the best care within the most appropriate setting. This includes rapid and efficient access to diagnostic services, Stroke expertise and medical and surgical interventions, rehabilitation and support for ongoing recovery and community reintegration. TAKING ACTION requires a committed team approach and strong coordination of care across regions and networks, with pre-hospital, acute care, rehabilitation and community-based healthcare providers working together to ensure optimal outcomes for patients and their families, regardless of geographic location.

9 TAKING ACTION also applies to patients who have experienced a Stroke , their families and informal caregivers. Stroke patients and their families need to actively participate in their recovery and openly communicate with their healthcare team. Patients and families must participate in setting the goals they want to achieve during recovery from a Stroke , and share concerns, as well as physical, mood and cognitive issues with their team, which will lead to the care required for optimal recovery in all aspects of health. Development of the Canadian best Practice Recommendations for Stroke Care For detailed methodology on the development and dissemination of the Canadian best Practice Recommendations for Stroke Care please refer to the Stroke best practices website at Acknowledgements The Canadian Stroke Network gratefully acknowledges the task group leaders and members, the external reviewers, all of who volunteered their time and expertise to this project.

10 We thank the Canadian Stroke Information and Evaluation Working Group for its work in updating and confirming the performance measures that accompany each recommendation. We acknowledge Corrine Davies-Schinkel for work on the systematic reviews of the literature and meeting coordination; and, we thank Marie-France Saint-Cyr and Jan Carbon for their work on the French translations. Canadian best Practice Recommendations for Stroke Care Overview Update 2012-2013 Fourth Edition FINAL Master Stroke Recommendation List Page 5 of 81 Funding The development of these Canadian Stroke care guidelines is funded in its entirety by the Canadian Stroke Network, which is in turn funded by the Networks of Centres of Excellence program.