James Sall, PhD; Blessen C. Eapen, MD; Johanna Elizabeth Tran, MD; Amy O. Bowles, MD; Andrew Bursaw, DO; M. Eric Rodgers, PhD
Financial Support: By the Department of Veterans Affairs.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1695.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Corresponding Author: James Sall, PhD, Department of Veterans Affairs, 811 Vermont Avenue NW, Washington, DC 20420.
Current Author Addresses: Drs. Sall, Tran, and Rodgers: Department of Veterans Affairs, 811 Vermont Avenue NW, Washington, DC 20420.
Dr. Eapen: VA Greater Los Angeles Health Care System, 11301 Wilshire Boulevard, Los Angeles, CA 90073.
Dr. Bowles: Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Author Contributions: Conception and design: B.C. Eapen, J.E. Tran.
Analysis and interpretation of the data: B.C. Eapen, J.E. Tran, A.O. Bowles.
Drafting of the article: J. Sall, B.C. Eapen, J.E. Tran, A.O. Bowles.
Critical revision of the article for important intellectual content: B.C. Eapen, J.E. Tran, A.O. Bowles.
Final approval of the article: J. Sall, B.C. Eapen, J.E. Tran, A.O. Bowles, M.E. Rodgers.
Administrative, technical, or logistic support: J. Sall, B.C. Eapen.
Collection and assembly of data: J.E. Tran.
In June 2019, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved an update of the joint clinical practice guideline for rehabilitation after stroke. This synopsis summarizes the key recommendations from this guideline.
In February 2018, the VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included clinical stakeholders and stroke survivors and conformed to the National Academy of Medicine (formerly the Institute of Medicine) tenets for trustworthy clinical practice guidelines. The guideline panel identified key questions, systematically searched and evaluated the literature, and developed 2 algorithms and 42 key recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Stroke survivors and their family members were invited to share their perspectives to further inform guideline development.
The guideline recommendations provide evidence-based guidance for the rehabilitation care of patients after stroke. The recommendations are applicable to health care providers in both primary care and rehabilitation. Key features of the guideline are recommendations in 6 areas: timing and approach; motor therapy; dysphagia; cognitive, speech, and sensory therapy; mental health therapy; and other functions, such as returning to work and driving.
Appendix Table 1. Management of Stroke Rehabilitation: Key Questions
Algorithm: rehabilitation disposition of the inpatient with stroke.
ADLs = activities of daily living; AHA = American Heart Association; ASA = American Stroke Association; CBT = cognitive behavioral therapy; IADLs = instrumental activities of daily living; PM&R = physical medicine and rehabilitation; SNRI = serotonin–norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor.
Algorithm: outpatient/community-based rehabilitation.
CBT = cognitive behavioral therapy; PM&R = physical medicine and rehabilitation; SNRI = serotonin–norepinephrine reuptake inhibitor; SSRI = selective serotonin reuptake inhibitor.
Appendix Table 2. Management of Stroke Rehabilitation
Sall J, Eapen BC, Tran JE, et al. The Management of Stroke Rehabilitation: A Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med. 2019;171:916–924. [Epub ahead of print 19 November 2019]. doi: https://doi.org/10.7326/M19-1695
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Published: Ann Intern Med. 2019;171(12):916-924.
Published at www.annals.org on 19 November 2019
Guidelines, Neurology, Stroke.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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