title: Canadian Stroke Best Practice Recommendations: Managing transitions of care following Stroke, Guidelines Update 2016.
abstract: Every year, approximately 62,000 people with stroke and transient ischemic attack are treated in Canadian hospitals. For patients, families and caregivers, this can be a difficult time of adjustment. The 2016 update of the Canadian Managing Transitions of Care following Stroke guideline is a comprehensive summary of current evidence-based and consensus-based recommendations appropriate for use by clinicians who provide care to patients following stroke across a broad range of settings. The focus of these recommendations is on support, education and skills training for patients, families and caregivers; effective discharge planning; interprofessional communication; adaptation in resuming activities of daily living; and transition to long-term care for patients who are unable to return to or remain at home. Unlike other modules contained in the Canadian Stroke Best Practice Recommendations (such as acute inpatient care), many of these recommendations are based on consensus opinion, or evidence level C, highlighting the absence of conventional evidence (i.e. randomized controlled trials) in this area of stroke care. The quality of care transitions between stages and settings may have a direct impact on patient and family outcomes such as coping, readmissions and functional recovery. While many qualitative and non-controlled studies were reviewed, this gap in evidence combined with the fact that mortality from stoke is decreasing and more people are living with the effects of stroke, underscores the need to channel a portion of available research funds to recovery and adaptation following the acute phase of stroke.
authors.affiliation: Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada Toronto Rehabilitation Institute, Toronto, Canada.
authors.forename: Jill I
authors.initials: JI
authors.lastname: Cameron
authors.affiliation: Faculty of Medicine, Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Canada Stan Cassidy Centre for Rehabilitation, Saint John, Canada.
authors.forename: Colleen
authors.initials: C
authors.lastname: O'Connell
authors.affiliation: Faculty of Nutrition Sciences, Western University, London, Canada workHORSE Consulting Inc., London, Canada.
authors.forename: Norine
authors.initials: N
authors.lastname: Foley
authors.affiliation: workHORSE Consulting Inc., London, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Salter
authors.affiliation: Nova Scotia Rehabilitation Centre, Halifax, Canada.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Booth
authors.affiliation: Department of Health, Chronic Disease Prevention and Management Unit, New Brunswick, Canada.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Boyle
authors.affiliation: South East Toronto Stroke Network, Toronto, Canada.
authors.forename: Donna
authors.initials: D
authors.lastname: Cheung
authors.affiliation: Ontario Long Term Care Association, Toronto, Canada Institute Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Cooper
authors.affiliation: Université de Sherbrooke, École de réadaptation, Québec, Canada.
authors.forename: Helene
authors.initials: H
authors.lastname: Corriveau
authors.affiliation: The Ottawa Hospital Stroke Program, Ottawa, Canada Faculty of Medicine, University of Ottawa, Ontario, Canada.
authors.forename: Dar
authors.initials: D
authors.lastname: Dowlatshahi
authors.affiliation: Stroke Survivor, Quebec, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Dulude
authors.affiliation: CONNECT Communities, British Columbia, Canada British Columbia Brain Injury Association, Vancouver, Canada.
authors.forename: Patti
authors.initials: P
authors.lastname: Flaherty
authors.affiliation: Heart and Stroke Foundation, Ottawa, Canada.
authors.forename: Ev
authors.initials: E
authors.lastname: Glasser
authors.affiliation: Faculty of Medicine, Dalhousie University, Nova Scotia, Canada Queen Elizabeth II Health Sciences Centre, Capital District Health Authority, Halifax, Canada.
authors.forename: Gord
authors.initials: G
authors.lastname: Gubitz
authors.affiliation: Toronto Rehabilitation Institute, Toronto, Canada.
authors.forename: Debbie
authors.initials: D
authors.lastname: Hebert
authors.affiliation: Integrated Primary Health Services, Sunrise Health Region, Saskatchewan, Canada.
authors.forename: Jacquie
authors.initials: J
authors.lastname: Holzmann
authors.affiliation: Stroke Rehabilitation Program, Bruyère Continuing Care, Ottawa, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hurteau
authors.affiliation: Villa Medica Hôpital de réadaptation, Quebec, Canada.
authors.forename: Elise
authors.initials: E
authors.lastname: Lamy
authors.affiliation: Saskatoon Health Region, Saskatoon, Canada.
authors.forename: Suzanne
authors.initials: S
authors.lastname: LeClaire
authors.affiliation: Winnipeg Regional Health Authority Home Care Program, Winnipeg, Canada.
authors.forename: Taylor
authors.initials: T
authors.lastname: McMillan
authors.affiliation: Mackenzie Health District Stroke Centre, Richmond Hill, Canada.
authors.forename: Judy
authors.initials: J
authors.lastname: Murray
authors.affiliation: Family Physician Practice, Windsor, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Scarfone
authors.affiliation: Calgary Stroke Program, Calgary, Canada Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Canada.
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: CARECORP Seniors Services, Vancouver, Canada.
authors.forename: Vivian
authors.initials: V
authors.lastname: Shum
authors.affiliation: Parkridge Centre, Saskatoon Health Region, Saskatoon, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Taylor
authors.affiliation: Carewest Dr. Vernon Fanning Centre, Calgary, Canada.
authors.forename: Trudy
authors.initials: T
authors.lastname: Taylor
authors.affiliation: Schulich School of Medicine & Dentistry, Western University - Windsor Program, Windsor, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Yanchula
authors.affiliation: Department of Physical Medicine and Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
authors.affiliation: Institute Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada Heart and Stroke Foundation, Ottawa, Canada plindsay@hsf.ca.
authors.forename: Patrice
authors.initials: P
authors.lastname: Lindsay
mesh_terms: D002170:Canada; D006801:Humans; D002546:Ischemic Attack, Transient / Q000628:therapy; D008134:Long-Term Care; D010353:Patient Education as Topic; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation
keywords: Stroke; guidelines; long-term care; patient education; reintegration; transitions