Increase Rehabilitation Time for Stroke Patients – NICE

The amount of rehabilitation time offered to adults in England who have had a stroke should be significantly increased from previous recommendations, the National Institute for Health and Care Excellence (NICE) said.

Previous guidance from 2013 recommended initially offering at least 45 minutes of relevant stroke rehabilitation therapy for a minimum of 5 days per week. However, NICE noted that current rehabilitation practice was “inconsistent” and not always provided to people after stroke. 

In an updated guideline, NICE said people aged over 16 years who had experienced a stroke should be offered needs-based rehabilitation for at least 3 hours a day on at least 5 days of the week.

Suitable rehabilitation would include physiotherapy, occupational therapy, and speech and language therapy.

More intensive physiotherapy led to faster recovery

Evidence reviewed by NICE’s appraisal committee found that “more intensive physiotherapy improved quality of life and activities of daily living”, and that stroke patients and their families and carers “felt that more intensive physiotherapy helped them recover faster, especially if it was delivered in the first 6 months after stroke”.

According to the Stroke Association, 85,000 people in England have strokes each year, while over one million people are stroke survivors. 

Stroke is one of the biggest causes of death in England. In 2017-18 cerebrovascular diseases, including stroke, accounted for just over 29,000 deaths in England per year, making it the 4th largest cause of death. However, improvements in stroke care and new, acute treatments have increased the overall survival rate from a first stroke over the past 10 years. This has led to increases in the number of people in the community needing post-stroke care and rehabilitation.

Extra costs should be weighed against longer term savings

While acknowledging that the updated guidance could impact on available resources, the NHS spending regulator predicted this would be “balanced out by long-term health benefits and potential care savings”.

We recognise the challenges the system faces in delivering these recommendations, not least the problems inherent in increasing service capacity and staff. We also know current practice is inconsistent, even when it comes to implementing our previous recommendations. But equally it shouldn’t be underestimated how important it is for people who have been left with disabilities following a stroke to be given the opportunity to benefit from the intensity and duration of rehabilitation therapies outlined in this updated guideline.”

Professor Jonathan Benger, chief medical officer at NICE

Dr Maeva May, associate director for policy and research at the Stroke Association, said: “Sadly, stroke is still a leading cause of adult disability and it has wide-ranging impacts so it’s vital that every stroke survivor gets the support they need to give them the best chance of recovery.

“Research shows that frequent and more intense rehabilitation leads to better recovery following a stroke but many stroke survivors only receive a fraction of what this guideline recommends, leaving many without support and limiting their improvement post-stroke.

“Every stroke is different and so is every recovery, so it’s important that stroke survivors can access person-centred support for as long as they need it, so they can regain their independence and rebuild their lives after stroke.”

NICE’s update guideline also makes recommendations in several other areas, including offering ‘telerehabilitation’ instead of, or as well as, face-to-face therapy, assessments for fatigue, and vision checks from an orthoptist.

The updated guidance was in line with the recently published National Clinical Guideline for Stroke, NICE said.