Canadian Stroke Best Practice Recommendations

Abstract

The seventh edition of the Canadian Stroke Best Practice Recommendations for Rehabilitation and Recovery following Stroke includes a new section devoted to the provision of virtual stroke rehabilitation. This consensus statement uses Grading of Recommendations, Assessment, Development and Evaluations methodology and Appraisal of Guidelines for Research & Evaluation II principles. A literature search was conducted using PubMed, Embase, and Cochrane databases. An expert writing group reviewed all evidence and developed recommendations, as well as consensus-based clinical considerations where evidence was insufficient for a recommendation. All recommendations underwent internal and external review. These recommendations apply to hospital, ambulatory care, and community-based settings where virtual stroke rehabilitation is provided. This guidance is relevant to health professionals, people living with stroke, healthcare administrators, and funders. Recommendations address issues of access, eligibility, consent and privacy, technology and planning, training and competency (for healthcare providers, patients and their families), assessment, service delivery, and evaluation. Virtual stroke rehabilitation has been shown to safely and effectively increase access to rehabilitation therapies and care providers, and uptake of these recommendations should be a priority in rehabilitation settings. They are key drivers of access to high-quality evidence-based stroke care regardless of geographical location and personal circumstances in Canada.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section)

“…44 Several SRs pointed to the comparable outcomes of telerehabilitation when compared to in-person traditional rehabilitation on upper extremity function and balance 45 , 46 with strong evidence for balance 47 as well as equivalency in some other outcomes such as Barthel Index 48 and ADL. 49 Guidelines 50 can be consulted for details of providing rehabilitation to individuals with stroke using telecommunication technologies.…”

“…3. It is recommended that PRM physicians, when applying telerehabilitation, identify barriers and enablers to achieve the IRP goals with potential solutions for quality management and quality improvement and to consider privacy issues in compliance with General Data Protection Regulation (GDPR) 19 , 20 , 50 [SoE: NA; SoR: A].…”

“…It is recommended that PRM physicians consider the diagnosis of other comorbidities beyond the primary diagnosis even remotely, with proper telecommunication technology and digital medicine platform. 11 , 12 , 21 , 50 One may refer to “WHO-ITU document” 116 regarding technical requirements for telehealth platforms for persons with disabilities with specific needs [SoE: NA; SoR: A].…”

Evaluations of virtual exercise programmes for adults with mobility limitations: a scoping review protocol incorporating an equity lens to inform the development of strategies to optimise participation of under-represented groups

“…Virtual exercise programmes can overcome personal and environmental barriers associated with in-person programmes 26. The effects of telerehabilitation services on everyday activities and mobility outcomes (including balance and gait) appear similar to the effects of in-person or usual care in people post-stroke27 and with multiple sclerosis 28.…”

Therapies Targeting Stroke Recovery

“…They are key drivers of access to high-quality evidence-based stroke care regardless of geographical location.” The authors emphasize that such telerehabilitation can be used for provision of therapy by occupational therapists, physical therapists, and speech therapists, as well as other purposes that include assessment, prevention, supervision, counseling and support, and education. 29…”