Teasell Robert W, Foley Norine C, Salter Katherine L, Jutai Jeffrey W
Stroke Rehabilitation & Assistive Technologies, Aging, Rehabilitation & Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada.
Arch Phys Med Rehabil. 2008 Mar;89(3):575-8. doi: 10.1016/j.apmr.2007.08.164.
Stroke is a major source of disability in Canada and other developed countries, which carries with it a high toll in terms of personal suffering for the stroke survivor and their family in addition to the associated economic costs. Despite the impressive body of evidence describing effective and feasible stroke rehabilitation practices, stroke survivors, their families, and health professionals currently do not benefit from a rehabilitation system that is well organized and evidence based. Using the principles of best evidence, we make the case for needed changes to the current system based on 5 processes of care known to be important in the pursuit of optimal outcomes: (1) admission to specialized stroke rehabilitation units, (2) early admission to stroke rehabilitation units, (3) intensive stroke rehabilitation therapies, (4) task-specific rehabilitation therapies, and (5) well-resourced outpatient programs. Implementation of these strategies will be expected to result in improved functional gain, fewer complications, decreased mortality, and reduced need for institutionalization. In addition to providing improved care for both the stroke survivor and their family, evidence-based stroke rehabilitation care is more efficient and may reduce costs. Our experience in Canada suggests that instituting these 5 measures alone will result in significant improvements to the health care system.
中风是加拿大和其他发达国家残疾的主要原因，除了相关的经济成本外，中风幸存者及其家人还要承受巨大的个人痛苦。尽管有大量证据描述了有效且可行的中风康复方法，但中风幸存者、他们的家人以及医疗专业人员目前并未从一个组织良好且基于证据的康复系统中受益。基于最佳证据原则，我们依据已知对实现最佳康复效果至关重要的5个护理流程，论证了对当前系统进行必要变革的理由：（1）入住专业中风康复单元；（2）尽早入住中风康复单元；（3）强化中风康复治疗；（4）针对特定任务的康复治疗；（5）资源充足的门诊项目。实施这些策略有望带来功能改善、并发症减少、死亡率降低以及机构收容需求减少。除了为中风幸存者及其家人提供更好的护理外，基于证据的中风康复护理更高效，还可能降低成本。我们在加拿大的经验表明，仅实施这5项措施就能显著改善医疗保健系统。
