Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC (P.W.D., C.B., M.S., S.C., M.R.).
School of Nursing, University of North Carolina at Wilmington (B.J.L.).
Stroke. 2021 Jan;52(1):385-393. doi: 10.1161/STROKEAHA.120.029678. Epub 2020 Dec 22.
Worldwide, stroke is prevalent, costly, and disabling in >80 million survivors. The burden of stroke is increasing despite incredible progress and advancements in evidence-based acute care therapies and despite the substantial changes being made in acute care stroke systems, processes, and quality metrics. Although there has been increased global emphasis on the importance of postacute stroke care, stroke system changes have not expanded to include postacute care and outcome follow-up. Our objectives are to describe the gaps and challenges in postacute stroke care and suboptimal stroke outcomes; to report on stroke survivors' and caregivers' perceptions of current postacute stroke care and their call for improvements in follow-up services for recovery and secondary prevention; and, ultimately, to make the case that a paradigm shift is needed in the definition of comprehensive stroke care and the designation of Comprehensive Stroke Center. Three recommendations are made for a paradigm shift in comprehensive stroke care: (1) criteria should be established for designation of rehabilitation readiness for Comprehensive Stroke Centers, (2) The American Heart Association/American Stroke Association implement an expanded Get With The Guidelines-Stroke program and criteria for comprehensive stroke centers to be inclusive of rehabilitation readiness and measure outcomes at 90 days, and (3) a public health campaign should be launched to offer hopeful and actionable messaging for secondary prevention and recovery of function and health. Now is the time to honor the patients' and caregivers' strongest ask: better access and improved secondary prevention, stroke rehabilitation, and personalized care.
在全球范围内，中风影响着超过 8000 万幸存者，不仅发病率高，且耗费巨大、致残率高。尽管在循证急救治疗方面取得了令人难以置信的进展和进步，尽管在急救卒中系统、流程和质量指标方面发生了重大变化，但卒中负担仍在不断增加。尽管人们越来越重视卒中后康复护理的重要性，但卒中系统的改变并未扩展到包括卒中后康复和结局随访。我们的目标是描述卒中后康复护理和卒中结局不佳方面的差距和挑战；报告卒中幸存者和护理人员对当前卒中后康复护理的看法，以及他们对改善康复和二级预防随访服务的呼吁；最终，提出需要在全面卒中护理的定义和综合性卒中中心的指定方面进行范式转变。为全面卒中护理的范式转变提出了三项建议：（1）应为综合卒中中心的康复准备制定标准，（2）美国心脏协会/美国卒中协会实施扩大的 Get With The Guidelines-Stroke 计划和综合卒中中心的标准，以包括康复准备，并在 90 天内测量结果，（3）应发起一场公共卫生运动，为二级预防以及功能和健康的恢复提供有希望和可行的信息。现在是时候满足患者和护理人员的强烈要求了：更好的获得途径和改进的二级预防、卒中康复以及个性化护理。
