Eapen Blessen C, Tran Johanna, Ballard-Hernandez Jennifer, Buelt Andrew, Hoppes Carrie W, Matthews Christine, Pundik Svetlana, Reston James, Tchopev Zahari, Wayman Lisa M, Koehn Tyler
Physical Medicine and Rehabilitation Services, Veterans Affairs Greater Los Angeles Health Care, and Division of Physical Medicine and Rehabilitation, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California (B.C.E.).
Comprehensive Integrated Inpatient Rehabilitation Program, James A. Haley Veterans' Hospital, Tampa, Florida (J.T.).
Ann Intern Med. 2025 Feb;178(2):249-268. doi: 10.7326/ANNALS-24-02205. Epub 2025 Jan 21.
In July 2024, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DOD) released a joint update of their 2019 clinical practice guideline (CPG) for the management of stroke rehabilitation. This synopsis is a condensed version of the 2024 CPG, highlighting the key aspects of the guideline development process and describing the major recommendations.
The VA/DOD Evidence-Based Practice Work Group convened a joint VA/DOD guideline development work group (WG) that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy CPGs. The guideline WG conducted a patient focus group, developed key questions, and systematically searched and evaluated the literature (English-language publications from 1 July 2018 to 2 May 2023). The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to evaluate the evidence. The WG developed 47 recommendations along with algorithms for stroke rehabilitation in the inpatient and outpatient settings. Stakeholders outside the WG reviewed the CPG before approval by the VA/DOD Evidence-Based Practice Work Group.
This synopsis summarizes where evidence is strongest to support guidelines in crucial areas relevant to primary care physicians: transition to community (case management, psychosocial or behavioral interventions); motor therapy (task-specific practice, mirror therapy, rhythmic auditory stimulation, electrical stimulation, botulinum toxin for spasticity); dysphagia, aphasia, and cognition (chin tuck against resistance, respiratory muscle strength training); and mental health (selective serotonin reuptake inhibitor use, psychotherapy, mindfulness-based therapies for treatment but not prevention of depression).
2024年7月，美国退伍军人事务部（VA）和美国国防部（DOD）发布了其2019年中风康复管理临床实践指南（CPG）的联合更新版。本概要为2024年CPG的精简版，突出了指南制定过程的关键方面，并描述了主要建议。
VA/DOD循证实践工作组召集了一个VA/DOD联合指南制定工作组（WG），其中包括临床利益相关者，并符合医学研究所关于可信CPG的原则。指南工作组开展了患者焦点小组讨论，提出了关键问题，并系统检索和评估了文献（2018年7月1日至2023年5月2日的英文出版物）。采用GRADE（推荐评估、制定和评价分级）系统对证据进行评估。工作组制定了47项建议以及住院和门诊环境中中风康复的算法。在VA/DOD循证实践工作组批准之前，工作组以外的利益相关者对CPG进行了审查。
本概要总结了在与初级保健医生相关的关键领域中，支持指南的证据最为充分的方面：向社区过渡（病例管理、心理社会或行为干预）；运动疗法（特定任务练习、镜像疗法、节律性听觉刺激、电刺激、用于痉挛的肉毒杆菌毒素）；吞咽困难、失语和认知（抗阻下颌后缩、呼吸肌力量训练）；以及心理健康（使用选择性5-羟色胺再摄取抑制剂、心理治疗、基于正念的疗法用于治疗而非预防抑郁症）。
