Winstein Carolee J, Stein Joel, Arena Ross, Bates Barbara, Cherney Leora R, Cramer Steven C, Deruyter Frank, Eng Janice J, Fisher Beth, Harvey Richard L, Lang Catherine E, MacKay-Lyons Marilyn, Ottenbacher Kenneth J, Pugh Sue, Reeves Mathew J, Richards Lorie G, Stiers William, Zorowitz Richard D
Stroke. 2016 Jun;47(6):e98-e169. doi: 10.1161/STR.0000000000000098. Epub 2016 May 4.
PURPOSE: The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS: Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS: Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS: As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
目的:本指南旨在概述中风康复期成人患者康复护理的最佳临床实践。 方法:写作组成员由委员会主席根据其在相关主题领域的既往工作提名,并经美国心脏协会(AHA)中风委员会科学声明监督委员会和AHA稿件监督委员会批准。该小组通过对截至2014年的医学文献进行计算机检索,回顾了有关成人的相关文章。证据按照AHA框架进行组织,并根据AHA/美国心脏病学会联合分类方法以及AHA补充分类方法对证据的确定性水平、类别和等级进行分类。该文件在提交AHA科学咨询与协调委员会审议和批准之前,经过了AHA广泛的内部和外部同行评审、中风委员会领导层评审以及科学声明监督委员会评审。 结果:中风康复需要一个大型团队持续且协调一致的努力,团队成员包括患者及其目标、家人和朋友、其他护理人员(如个人护理员)、医生、护士、物理治疗师和职业治疗师、言语语言病理学家、娱乐治疗师、心理学家、营养师、社会工作者等。这些团队成员之间的沟通与协调对于最大限度地提高康复的有效性和效率至关重要,也是本指南的基础。没有沟通与协调,孤立地对中风幸存者进行康复治疗不太可能充分发挥其潜力。 结论:随着医疗保健改革努力推动护理体系的发展,急性后期护理和康复通常被视为一个成本高昂、需要削减的护理领域,但却未认识到它们的临床影响以及降低因活动受限、抑郁、自主性丧失和功能独立性降低导致的下游医疗发病率风险的能力。提供资源充足、剂量合适且持续时间足够的综合康复计划是中风护理的一个重要方面,应成为这些重新设计工作的优先事项。(《中风》.2016;47:e98 - e169。DOI:10.1161/STR.0000000000000098。)
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