Nelson Michelle L A, Kelloway Linda, Dawson Deirdre, McClure J Andrew, McKellar Kaileah A, Menon Anita, Munce Sarah, Ronald Kara, Teasell Robert, Wasdell Michael, Lyons Renee F
Ontario Stroke Network, Toronto, ON, Canada.
Institute of Clinical Evaluative Sciences, London, ON, Canada.
J Comorb. 2015 Feb 17;5:1-10. doi: 10.15256/joc.2015.5.47. eCollection 2015.
Stroke care presents unique challenges for clinicians, as most strokes occur in the context of other medical diagnoses. An assessment of capacity for implementing "best practice" stroke care found clinicians reporting a strong need for training specific to patient/system complexity and multimorbidity. With mounting patient complexity, there is pressure to implement new models of healthcare delivery for both quality and financial sustainability. Policy makers and administrators are turning to clinical practice guidelines to support decision-making and resource allocation. Stroke rehabilitation programs across Canada are being transformed to better align with the Canadian Stroke Strategy's Stroke Best Practice Recommendations. The recommendations provide a framework to facilitate the adoption of evidence-based best practices in stroke across the continuum of care. However, given the increasing and emerging complexity of patients with stroke in terms of multimorbidity, the evidence supporting clinical practice guidelines may not align with the current patient population. To evaluate this, electronic databases and gray literature will be searched, including published or unpublished studies of quantitative, qualitative or mixed-methods research designs. Team members will screen the literature and abstract the data. Results will present a numerical account of the amount, type, and distribution of the studies included and a thematic analysis and concept map of the results. This review represents the first attempt to map the available literature on stroke rehabilitation and multimorbidity, and identify gaps in the existing research. The results will be relevant for knowledge users concerned with stroke rehabilitation by expanding the understanding of the current evidence.
中风护理给临床医生带来了独特的挑战，因为大多数中风发生在伴有其他医学诊断的情况下。一项关于实施“最佳实践”中风护理能力的评估发现，临床医生表示非常需要针对患者/系统复杂性和多种疾病共存情况的培训。随着患者复杂性的增加，为了保证质量和财务可持续性，实施新的医疗服务模式面临着压力。政策制定者和管理人员正在求助于临床实践指南来支持决策和资源分配。加拿大各地的中风康复项目正在进行变革，以更好地符合《加拿大中风战略》的中风最佳实践建议。这些建议提供了一个框架，以促进在整个护理过程中采用基于证据的中风最佳实践。然而，鉴于中风患者在多种疾病共存方面日益增加和新出现的复杂性，支持临床实践指南的证据可能与当前的患者群体不一致。为了对此进行评估，将检索电子数据库和灰色文献，包括已发表或未发表的定量、定性或混合方法研究设计的研究。团队成员将筛选文献并提取数据。结果将呈现所纳入研究的数量、类型和分布的数字说明，以及结果的主题分析和概念图。本综述是首次尝试梳理关于中风康复和多种疾病共存的现有文献，并找出现有研究中的差距。通过扩大对当前证据的理解，研究结果将与关注中风康复的知识使用者相关。
