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Department of Veterans Affairs
Department of Defense
American Heart Association/ American Stroke Association
Guideline Summary
With support from:
The Office of Quality and Performance, VA, Washington, DC
&
Quality Management Division, United States Army MEDCOM
Full guideline available at:
http://www.healthquality.va.gov or, http://www.qmo.amedd.army.mil
QUALIFYING STATEMENTS
The Department of Veterans Affairs (VA) and The Department of Defense (DoD) guidelines are based on the best information available at the time of publication. They are designed to provide information and assist in decision-making. They are not intended to define a standard of care and should not be construed as one. Also, they should not be interpreted as prescribing an exclusive course of management.
Variations in practice will inevitably and appropriately occur when providers take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of these guidelines is responsible for evaluating the appropriateness of applying them in any particular clinical situation.
INTRODUCTION
This update of the Clinical Practice Guideline for the Management of Stroke Rehabilitation was developed under the auspices of the Veterans Health Administration (VHA) and the Department of Defense (DoD) pursuant to directives from the Department of Veterans Affairs (VA). VHA and DoD define clinical practice guidelines as follows:
"Recommendations for the performance or exclusion of specific procedures or services derived through a rigorous methodological approach that includes:
Determination of appropriate criteria, such as effectiveness, efficacy, population benefit, or patient satisfaction and a literature review to determine the strength of the evidence in relation to these criteria."
This VA/DoD Stroke Rehabilitation guideline update builds on the 1996 VA Stroke/Lower Extremity Amputee Algorithms Guide and the 2003 VA/DoD Guideline for the Management of Stroke Rehabilitation in the Primary Care Setting. The 2003 version of this guideline focused on stroke rehabilitation, utilizing a team model of intervention and interactions with patients and families (caregivers & support systems).
Algorithms:
This guideline has been developed using an algorithmic approach to guide the clinician in determining care and the sequencing of interventions on a patient-specific basis. The clinical algorithm incorporates the information presented in the guideline in a format that maximally facilitates clinical decision-making. The use of the algorithmic format was chosen because such a format improves data...