Top Stroke Rehabil
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It is a concern that the consistency of care in stroke rehabilitation appears to vary significantly among practice settings within Canada. Based upon an evidence-based review of stroke rehabilitation, a group of physiatrists from across Canada agreed to some basic standards for stroke rehabilitation. ⋯ Providing stroke rehabilitation care consistently within these standards remains a challenge, particularly given the potential initial costs, despite significant improvements in patient outcomes and quality of life. Nevertheless, these standards should be the expectation of stroke patients, essentially forming a stroke rehabilitation "bill of rights."
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Review Case Reports
Is informed consent a "yes or no" response? Enhancing the shared decision-making process for persons with aphasia.
Respect for patient autonomy and the need to have a comprehensive discussion of the risks and benefits of a medical intervention are two important issues involved in the process of obtaining informed consent. In dealing with individuals with aphasia, there may be particular challenges in balancing these two ethical imperatives. ⋯ We propose a process of enhancing informed consent for persons with aphasia while continuing to respect and enhance patient autonomy and the exercise of decision making for these patients. The use of a patient-selected "helper" during the informed consent process can improve the quality of the informed consent, while reserving final decision-making authority for the patient.
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Multicenter Study Comparative Study
Antiplatelet and anticoagulant medication usage during stroke rehabilitation: the Post-Stroke Rehabilitation Outcomes Project (PSROP).
Secondary prevention of strokes is an important issue during the admission to the inpatient rehabilitation facility (IRF). There are many clinical practice guidelines with strong levels of evidence that address the secondary prophylaxis of strokes. The Post-Stroke Rehabilitation Outcomes Project (PSROP) database was used to describe the frequency that antiplatelet and/or anticoagulant medications are prescribed for the secondary prophylaxis of a stroke. ⋯ Of 173 participants who had an embolic event, 29 (16.8%) did not receive a salicylate, antiplatelet agent, or warfarin. Unless patients have any medical contraindications to these medications, they should receive these evidence-based treatments for secondary stroke prophylaxis. As more stroke survivors receive antiplatelet and/or anticoagulant medications, it is more likely that the incidence of recurrent strokes will decrease.
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Multicenter Study Comparative Study
Usage of pain medications during stroke rehabilitation: the Post-Stroke Rehabilitation Outcomes Project (PSROP).
Pain remains one of the most common, yet most challenging, medical problems in health care today, and it is one of the most common complications that occurs after a stroke. Pain can affect the course of stroke rehabilitation adversely, and it occasionally may be a cause for transfer back to an acute care hospital. The Post-Stroke Rehabilitation Outcomes Project (PSROP) database was used to describe the incidence of pain by body location and trends in the use of different classifications of medications to treat pain. ⋯ Other frequently prescribed pain medications included sumatriptan (migraine analgesic), cyclobenzaprine (muscle relaxant), and baclofen (antispasticity muscle relaxant). Medications should be chosen based upon the medical condition causing pain, the ability of the stroke survivor to comply with administration of the medication, and the cost of the medication. Appropriate and timely treatments of painful conditions result in maximum function and the ability to lead active lives and maintain an adequate quality of life.
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Review
Opening the black box of stroke rehabilitation with clinical practice improvement methodology.
Although stroke survivors are the largest consumer group for postacute rehabilitation services, there has been little quantification of the details of poststroke rehabilitation (PSR), with the major exception of the AHCPR Clinical Practice Guidelines #16 of 1995. The gold standard research methodology of a randomized controlled trial cannot practically encompass PSR. Using clinical practice improvement (CPI), a statistically based, validated research methodology, a mathematical representation of the inpatient stroke rehabilitation experience has been constructed. This article examines the principle aspects of CPI methodology and how it was adapted to a multicenter study of inpatient PSR.