Q&A: Stroke rehabilitation guideline helps physicians 'provide holistic care' for veterans
Key takeaways:
- The U.S. Departments of Veterans Affairs and Defense updated their clinical practice guidance for managing stroke rehabilitation.
- It includes algorithms to guide decision-making but stresses personalized care.
With a new clinical practice guideline, primary care providers can offer the best stroke rehabilitation care possible to service members and veterans, according to an expert.
Together, the U.S. Departments of Veterans Affairs (VA) and Defense (DoD) recently released an update to their 2019 clinical practice guidance for managing stroke rehabilitation.
Blessen C. Eapen, MD, chief of physical medicine and rehabilitation at The VA Greater Los Angeles Healthcare System, and colleagues published a condensed version of the guidance, describing major recommendations and highlighting its key aspects in Annals of Internal Medicine. Some of those key items include information about transition to community-based care, motor therapy and mental health.
Healio spoke with Eapen to learn more about the guidelines and what PCPs need to know.
Healio: What are the key aspects of this guidance?
Eapen: The VA/DoD Management of Stroke Rehabilitation 2024 Clinical Practice Guideline (CPG) provides recommendations for the interprofessional team that cares for adult patients who have experienced a stroke. The CPG focused on the following areas: motor, cognitive/speech/language, dysphagia, spasticity, mental/behavioral health, sensory rehabilitation, neglect, technology-assisted tools, settings/models of care and caregiver support.
Healio: What are the updates in these guidelines? What has changed after release of the 2019 recommendations?
Eapen: The following significant updates to the 2019 VA/DoD Stroke Rehabilitation CPG make it important that providers review this version of the CPG:
- updated algorithm and sidebars to define a clinical flow;
- added 24 new recommendations;
- reviewed and replaced 19 recommendations;
- reviewed and amended three recommendations; and
- deleted 16 recommendations.
Additional updates include an initial or expanded literature search or both into complementary and integrative health — including acupuncture — noninvasive brain stimulation techniques, management of post-stroke spasticity and technology-based modalities — including virtual reality.
Healio: How does this guidance differ from that of other major organizations?
Eapen: This evidence-based guideline uniquely offers the most up-to-date review of the management of common stroke sequelae, and the rehabilitation systems and processes. It is in contrast to the American Heart Association (AHA)/American Stroke Association (ASA) guidelines on the early management of acute ischemic stroke, secondary prevention of stroke and management of spontaneous intracerebral hemorrhage, which are focused on the acute management of ischemic and hemorrhagic stroke, as well secondary stroke prevention, which are also vital stages of the stroke care continuum.
The more closely related AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery were last published in 2016. Although also focused on management of stroke sequelae, its scope was broader and included system-level considerations, prevention and medical management of comorbidities, sequelae assessments and tools, sensorimotor treatments or interventions, and transitions of care and community rehabilitation. Most of those guidelines have formed current practice and standards of care. Our guidelines have benefited from these prior publications and sought to continue to propel the best clinical practices in adult stroke rehabilitation and guide future research.
Healio: Are there any nuances PCPs should consider? For example, should they deviate from these guidelines based on certain patient characteristics?
Eapen: The CPG encourages providers to practice shared decision-making, a process in which providers, patients and patient care partners (eg, family, friends, caregivers) consider clinical evidence of benefits and risks, as well as patient values and preferences, to make decisions regarding the patient’s treatment. The CPG includes two algorithms to assist with decision-making: Module A: Rehabilitation Disposition of the Inpatient with Stroke and Module B: Outpatient/Community-Based Rehabilitation. The algorithms have accompanying sidebars to describe nuances of patient characteristics and other factors that influence clinical decisions.
Healio: What is the take-home message for PCPs?
Eapen: The VA/DoD Stroke Rehabilitation guidelines provide clear, evidence-based recommendations on the rehabilitation process after a stroke. This helps clinicians understand the most effective interventions and therapies for patients in the recovery phase, such as physical, occupational and speech therapy.
Post-stroke depression and other mental health challenges are common. The guidelines emphasize the importance of recognizing and addressing mental health issues in stroke rehabilitation. This helps PCPs provide holistic care by incorporating psychological support and mental health resources into their treatment plan. By following these recommendations, PCPs can ensure that stroke survivors receive comprehensive, interdisciplinary rehabilitation.
Rehabilitation isn't just about physical recovery — it’s also about reintegrating stroke survivors into their social and professional lives.
Healio: Is there anything else you would like to add?
Eapen: VA/DoD Stroke Rehabilitation CPG provides PCPs with a comprehensive, structured approach to managing stroke survivors, focusing on rehabilitation, long-term care, and coordination with other specialists. By following these guidelines, PCPs can enhance recovery outcomes, improve quality of life for stroke survivors, and reduce the risk of further complications.
The VA/DoD Clinical Practice Guidelines are designed to enhance the quality, efficiency and consistency of care for veterans and service members, making it easier for PCPs to manage and treat their patients. By using these guidelines, PCPs can confidently follow best practices and offer the best possible care for the unique needs of veterans and service members.