EBP Compendium: Summary of Clinical Practice Guideline
Catalan Agency for Health Technology Assessment and Research
Stroke: Clinical Practice Guideline (2nd edition)
Catalan Agency for Health Technology Assessment and Research.
Barcelona (Spain): Catalan Agency for Health Technology Assessment and Research, 112 pages.
AGREE Rating: Highly Recommended
This guideline provides recommendations for the assessment, management, and rehabilitation of acute stroke in adults. The target audiences for this guideline include professionals, managers, and planners. Recommendations are graded A, B, C, D, or "Point of Good Practice" based on the strength of supporting evidence. Grade A recommendations are based on evidence from systematic reviews and meta-analyses of randomized controlled trials that are directly relevant to the population. Grade B recommendations include high quality case control or cohort studies or high quality systematic reviews of those studies that are directly applicable to the population, or recommendations extrapolated from Grade A evidence. Grade C recommendations include well conducted case control or cohort studies or recommendations extrapolated from Grade B evidence. Grade D recommendations are based on evidence from non-analytic studies or expert opinion or recommendations extrapolated from Grade C evidence. Points of Good Practice are recommendations based on the clinical experience of the guideline development group.
- Assessment Areas
- Language - “All patients with a lesion in the dominant hemisphere that present language alterations should be assessed by a speech and language therapist using valid and reliable methods” (Grade C Evidence) (p. 67).
- Speech - “Patients with dysarthria must be referred to a speech and language therapist for assessment and guidance. The specialist will make the differential diagnosis and will carry out the treatment, and will determine the time and type of intervention, as well as the needs for amplification and alternative communication systems” (Point of Good Practice) (p. 68).
- Swallowing - “If there is suspicion of dysphagia and/or risk of pulmonary aspiration, the patient must be evaluated by a trained specialist who will determine the conditions for safe swallowing, as well as the consistency of the solid and liquid diet” (level A) (p. 56).
- Assessment Instruments
- Bedside Swallow Exam - “The assessment of dysphagia must be made as soon as possible, preferably in the course of admission, with a simple and validated clinical swallowing test. The nausea reflex test is not a valid swallowing test. Current scientific evidence lends greater support to voluntary cough and the sensitive pharynx test” (Grade B Evidence) (p. 56).
- Videofluoroscopy - “The use of videofluoroscopy must be assessed when alterations are detected in the clinical swallowing test. If the alteration of the pharyngeal phase of swallowing persists, instrumental and dynamic tests must be considered to view the pharynx during the passage of different volumes and consistencies of food” (Grade B Evidence) (p. 56).
- General Findings - “Patients must learn problem-solving strategies and how to apply them in everyday situations and in functional activities in the post acute phase of the rehabilitation” (Grade D Evidence) (p. 69).
- Compensatory Memory Treatments - “Specific interventions targeting facilitating the learning of compensatory strategies (sound alarms, notebooks, diaries, electronic organizers, etc.) are recommended in patients with memory deficits” (Grade B Evidence) (p. 68).
- Compensatory Executive Function Treatments - “Patients with alteration of executive functions must be taught compensatory techniques such as the use of electronic organizers or written lists of needs to improve the execution of ADL” (Grade B Evidence) (p. 69).
- Drill and Practice Attention Training - “Patients with attention disorders must receive treatment targeting the improvement of the level of alertness and the capacity to sustain attention” (Grade B Evidence) (p. 68).
- Visual Neglect Treatment - “Patients with persistent and disabling neglect/spatial inattention must be treated with specific techniques such as cueing, scanning, limb activation, aids and adaptations of the environment” (Grade B Evidence) (p. 68).
- Apraxia Treatment - “Patients with apraxia must be instructed in the use of internal and external aids (e.g., verbalization and following written/pictorial action sequences)” (Grade A Evidence) (p. 69).
- “If the patient presents aphasia, the speech and language therapist must inform the staff and the family of such deficiencies and disabilities and facilitate communication techniques that are suitable for the deficit” (Grade A Evidence) (p. 67).
- “As long as there are identifiable objectives and demonstrable progress, the patient with communication disabilities should continue to receive suitable treatment, and periodical assessments of this programme must be made” (Grade D Evidence) (p. 67).
- Service Delivery
- “The speech and language therapist must assess the convenience of an intensive speech and language therapy. The studies suggest that between two and eight hours a week of speech and language therapy should be provided” (Grade B Evidence) (p. 67).
- “Intensive speech therapy in a short period of time improves the results of therapy in patients with aphasia after a stroke” (Grade B Evidence) (p. 67).
- “The recovery of aphasia patients is more significant in patients treated by a speech therapist” (Grade B Evidence) (p. 67).
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Added to Compendium: November 2011