On April 30, 2007, the Heart and Stroke Foundation of Ontario published its “Consensus Panel on the Stroke Rehabilitation System.” This report was based on an extensive review of the research literature and included many references to the Canadian Stroke Strategy’s “Best Practice Recommendations for Stroke Care” (2006, updated in 2008). Key excerpts regarding rehabilitation are as follows:
“All patients admitted to hospital with acute stroke will have an early initial rehabilitation assessment by relevant rehabilitation professionals as soon as possible after admission within the first 24-48 hours. Weekends will not limit “time to assessment.””
“All stroke survivors (excluding TIAs) who are not admitted to hospital or who are discharged home from acute care will undergo an ambulatory or home-based screening assessment, which includes a medical, functional and cognitive assessment, by professionals with expertise in stroke, within two weeks.”
“The Blueprint concludes, based on recently published studies, that “greater intensities of rehabilitation therapies result in improved stroke outcomes. The combination of high-intensity therapies provided early in the course of the stroke recovery provides the greatest benefit.””
“Stroke survivors will receive the appropriate intensity and duration of clinically relevant therapies across the care continuum based on individual need and tolerance.
- Mild stroke: Stroke survivors discharged to the community will be provided with ambulatory services for one hour of each appropriate therapy, two to five times per week, as tolerated by the patient and as indicated by patient need.
- Moderate stroke: Survivors of a moderate stroke will receive a minimum of one hour of direct therapy time for each relevant core therapy, with an individualized treatment plan, for a minimum of five days per week, by the interprofessional stroke team based on individual need and tolerance.
- Severe stroke: Survivors of a severe stroke who are Rehab Ready will receive the frequency and duration of therapy that can be tolerated; the interprofessional team will increase the frequency and duration as tolerance improves to a minimum target of one hour of direct therapy time for each relevant core therapy, with an individualized treatment plan, for a minimum of five days per week, by the interprofessional stroke team based on individual need and tolerance.”
“The wait time from when the stroke survivor is Rehab Ready and referred to rehabilitation services until the start of all appropriate rehabilitation services should be no more than:
- Two business days for inpatient stroke rehabilitation, and
- Five days for both ambulatory and home-based stroke rehabilitation.”