Introduction

Stroke is a major health problem in the UK. Each year, approximately 110,000 people in England, 11,000 people in Wales and 4,000 people in Northern Ireland have a first or recurrent stroke. Most people survive a first stroke but often have significant morbidity. More than 900,000 people in England are living with the effects of stroke.

Stroke mortality rates in the UK have been falling steadily since the late 1960s. The development of stroke units following the publication of the Stroke Unit Trialists' Collaboration meta-analysis of stroke unit care[1], and the further reorganisation of services following the advent of thrombolysis, have resulted in further significant improvements in mortality and morbidity from stroke (as documented in the National sentinel stroke audit[2]). However, the burden of stroke may increase in the future as a consequence of the ageing population.

Despite improvements in mortality and morbidity, people with stroke need access to effective rehabilitation services. Stroke rehabilitation is a multidimensional process, which is designed to facilitate restoration of, or adaptation to the loss of, physiological or psychological function when reversal of the underlying pathological process is incomplete. Rehabilitation aims to enhance functional activities and participation in society and thus improve quality of life.

Key aspects of rehabilitation care include multidisciplinary assessment, identification of functional difficulties and their measurement, treatment planning through goal setting, delivery of interventions which may either effect change or support the person in managing persisting change, and evaluation of effectiveness.

Current guidelines

Clear standards exist for stroke rehabilitation, for instance as described by the 'National clinical guideline for stroke'[3] and reflected in the NICE quality standard and the 'National stroke strategy'[4]. Overall there is little doubt that the rehabilitation approach described by the standards is effective; what individual interventions should take place within this structure is less clear.

Why this guideline was developed

The aim of this Guideline Development Group was to review the structure, processes and interventions currently used in rehabilitation care, and to evaluate whether they improve outcomes for people with stroke. A modified Delphi survey was conducted (see the full guideline for more information) to obtain formal consensus around areas such as service delivery and care planning. This guideline reviews some of the available interventions that can be used in stroke rehabilitation.



[1] Stroke Unit Trialists' Collaboration (1997) Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke. British Medical Journal (Clinical Research Ed) 314:1151–9

[2] Intercollegiate Stroke Working Party (2011) National sentinel stroke clinical audit 2010 (round 7): public report for England, Wales and Northern Ireland. London: Royal College of Physicians.

[3] Intercollegiate Stroke Working Party (2008) National clinical guideline for stroke: third edition. London: Royal College of Physicians.

[4] Department of Health (2007) National stroke strategy. London: Department of Health.

  • National Institute for Health and Care Excellence (NICE)