Evidence
Surveillance decision
We will update the guideline on stroke rehabilitation in adults.
NICE is engaging with the Royal College of Physicians Intercollegiate Stroke Working Party in the update of the guideline.
Reasons for the decision
The surveillance review identified that the evidence base for some aspects of stroke rehabilitation has progressed since the guideline was developed in 2013. Additionally, feedback from topic experts and stakeholders highlighted the following that impact on the relevance of the guideline to current practice:
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Limited implementation of some of the guideline recommendations.
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Lack of integration between the guideline and NICE's guideline on stroke and transient ischaemic attack in over 16s (which focuses on the first 48 hours after symptom onset), which could make improving integration of acute care and rehabilitation services in practice difficult.
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Lack of alignment with the 2016 Royal College of Physicians Intercollegiate Stroke Working Party guidelines, which may be confusing for the health and social care setting.
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Changes in how stroke rehabilitation services are structured, therefore changing the context in which the guideline was developed.
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New policy imperatives for stroke as outlined in the NHS Long Term Plan (January 2019), which make the position of the current guideline uncertain.
The following table gives an overview of how evidence and intelligence identified in surveillance might affect each area of the guideline:
|
(see appendix A for more information) |
New evidence identified to impact guideline |
New intelligence identified to impact guideline |
|
Organising health and social care for people needing rehabilitation after stroke |
No |
Yes |
|
Planning and delivering stroke rehabilitation |
No |
Yes |
|
Providing support and information |
No |
No |
|
Cognitive functioning |
No |
No |
|
Emotional functioning |
Yes |
Yes |
|
Vision |
No |
Yes |
|
Swallowing |
Yes |
Yes |
|
Communication |
Yes |
No |
|
Movement |
Yes |
Yes |
|
Self-care |
Yes |
No |
|
Long-term health and social support |
No |
No |
|
Areas not currently covered in the guideline |
||
|
Transcutaneous electrical nerve stimulation (TENS) for spasticity |
Yes |
No |
|
Music therapy |
Yes |
No |
|
Mirror therapy |
Yes |
No |
|
Pharmacological therapies |
Yes |
Yes |
|
Other areas including peripheral magnetic stimulation; transcranial magnetic stimulation; transcranial electrical stimulation; telerehabilitation and active telephone support; rehabilitation for car driving; virtual reality; post-stroke fatigue; acupuncture; vibration therapy; art therapy and other pharmacological therapies |
No |
No |
For further details and a summary of all evidence and intelligence identified in surveillance, see appendix A.
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