Too many stroke patients miss out on the window to regain crucial functions

October 03, 2014

Too many stroke patients in Canada are not getting the rehabilitation they need to return to a healthy, active life, according to a new study which will be presented at the Canadian Stroke Congress in Vancouver tomorrow. The research findings strongly suggest that such decisions are being made based on what services are available in the health system rather than what patients really need. It found that overall just 16 per cent of patients with stroke were discharged to inpatient rehabilitation but that the rates varied widely by province (1% to 26%) and hospital (0% to 48%). Meanwhile, some of the people who do get rehabilitation don't need it. And those who do get rehabilitation don't always get the right amount of services.

Stroke experts agree that about 40 per cent of stroke patients would benefit from rehabilitation which takes place in a specialized rehabilitation unit where patients stay for one to several weeks following discharge from acute care.

"The study suggests there are a large number of Canadian stroke patients who are not getting the help they need at hospital discharge to get back to an active life," says Dr. Michael Hill, director of the stroke unit at the Foothills Medical Centre in Calgary and one of the study authors.

"We found that access to and the use of inpatient rehabilitation after stroke is highly variable, so variable that it likely depends upon practice patterns and resources, rather than patient disability and needs."

"Stroke patients are falling through the cracks," says Dr. Mark Bayley, co-chair of the Canadian Stroke Congress and a physiatrist (rehabilitation specialist). "This has huge implications for their future quality of life and use of healthcare and social service resources."

He adds that the study highlights the need for more formal assessment and triage processes to better match patients and their needs to finite rehabilitation services.

The study examined the database of hospital discharge information maintained by the Canadian Institute of Health Information (CIHI), focusing on the nearly 60,000 stroke or transient ischemic attack (TIA or mini stroke) patients discharged from Canadian hospitals over a two-year period ending in March 2013.

The hospital discharge data are important, says Dr. Hill, because it is crucial for stroke patients to get rehabilitation promptly after their stroke. "There is a window when rehabilitation after stroke is maximally effective," he says. "We need to pay attention to getting people help within this window - before the opportunity for improvement has decreased - if we want to get people back to being as fully functioning as possible in their daily activities and jobs."

He adds that people with moderate and moderately severe disability are the ones that can benefit most from timely access to the right level of rehabilitation services.

Hot Topic in Stroke: Access to Stroke Rehabilitation

A majority of people who have a stroke report that they need some amount of help afterwards and 80 per cent experience restrictions to their daily activities. Recovery from a stroke can continue for years. "Lack of adequate rehabilitation resources means patients and families are denied the opportunity to have as much function restored as possible," says Ian Joiner, director of stroke for the Heart and Stroke Foundation. "Our health and social services systems ultimately pay more because patients do not meet their recovery potential and end up needing more services. It simply makes sense to make stroke rehabilitation a priority." While there have been improvements over the past decade in how quickly stroke survivors are getting access to inpatient rehabilitation, there's still work to be done.

"The Heart and Stroke Foundation recommends that governments explore opportunities to enhance post-stroke rehabilitation services," says Joiner. "In addition to the variation in access to inpatient rehabilitation services, community-based rehabilitation programs are not available in many communities, and those that do exist are not equitably covered by provincial health insurance programs."

Research Creates Survivors

Growing up, Janel Nadeau had a passion for science and imagined travelling to another province to pursue her university studies. At the age of 19, a sudden stroke seemingly robbed her of that dream.

Janel spent six weeks in hospital, where she was one of the lucky ones who received a full complement of rehabilitation support, including occupational, physical and speech therapy. Yet when she got home, the first-year Honour's student at Queen's University was still struggling to relearn the alphabet.

Her mom took four months off work so she could accompany Janel to weekly physical therapy sessions at the hospital and help her with exercises at home. They sought out opportunities in the community, including the local gym for strength training, swimming and yoga, cooking classes through adult education and massage therapy.

The support she received through her recovery allowed her to eventually return to her studies. Today, she is a resident physician who works alongside the doctors who saved her life at Foothills Medical Centre, including Dr. Michael Hill.

Investments in stroke rehabilitation and increased rehabilitation availability will result in more survivors thriving, like Janel.

Stroke's Impact by the Numbers
-end-
Statements and conclusions of study authors are solely those of the study authors and do not necessarily reflect HSF or CSC policy or position. The Heart and Stroke Foundation and the Canadian Stroke Consortium make no representation or warranty as to their accuracy or reliability.

About the Heart and Stroke Foundation

The Heart and Stroke Foundation's mission is to prevent disease, save lives and promote recovery. A volunteer-based health charity, we strive to tangibly improve the health of every Canadian family, every day. Healthy lives free of heart disease and stroke. Together we will make it happen. heartandstroke.ca

Congress information and media registration is at http://www.strokecongress.ca

After October 7, 2014, contact:

Jane-Diane Fraser
Heart and Stroke Foundation of Canada
jfraser@hsf.ca, (613) 691-4020

Heart and Stroke Foundation of Canada

Related Stroke Articles from Brightsurf:

Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care
An interactive, digital alarm clock may speed emergency stroke care, starting at hospital arrival and through each step of the time-sensitive treatment process.

Stroke patients with COVID-19 have increased inflammation, stroke severity and death
Stroke patients who also have COVID-19 showed increased systemic inflammation, a more serious stroke severity and a much higher rate of death, compared to stroke patients who did not have COVID-19, according a retrospective, observational, cross-sectional study of 60 ischemic stroke patients admitted to UAB Hospital between late March and early May 2020.

'Time is vision' after a stroke
University of Rochester researchers studied stroke patients who experienced vision loss and found that the patients retained some visual abilities immediately after the stroke but these abilities diminished gradually and eventually disappeared permanently after approximately six months.

More stroke awareness, better eating habits may help reduce stroke risk for young adult African-Americans
Young African-Americans are experiencing higher rates of stroke because of health conditions such as high blood pressure, diabetes and obesity, yet their perception of their stroke risk is low.

How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.

Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.

High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.

Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.

We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.

Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.

Read More: Stroke News and Stroke Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.