title: A blueprint for transforming stroke rehabilitation care in Canada: the case for change.
abstract: 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.
authors.affiliation: Stroke Rehabilitation & Assistive Technologies, Aging, Rehabilitation & Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada. Robert.teasell@sjhc.london.on.ca
authors.forename: Robert W
authors.initials: RW
authors.lastname: Teasell
authors.forename: Norine C
authors.initials: NC
authors.lastname: Foley
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Salter
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Jutai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards / Q000639:trends; D002170:Canada; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D026741:Physical Therapy Modalities / Q000191:economics; D017410:Practice Guidelines as Topic; D012047:Rehabilitation Centers / Q000191:economics / Q000592:standards; D018570:Risk Assessment; D020521:Stroke / Q000175:diagnosis / Q000401:mortality*; D000071939:Stroke Rehabilitation; D014481:United States