Priority 11 Stroke Rehabilitation and Long-term Care

UNCERTAINTY: What is the best intervention to improve outcomes for people with severe stroke and long-term disability, and what can be gained from longer-term rehabilitation provided at home and in nursing homes?  (JLA PSP Priority 11)
Overall ranking 11
JLA question ID 0106/11b
Explanatory note

Two‐thirds of UK stroke survivors leave hospital with a disability (calculated using SSNAPP 2020 data). As such, stroke generates considerable health and social care costs. In the UK, costs are estimated at £8 billion a year, including £3 billion direct costs to the National Health Service, as well as other wider economic costs such as informal care costs, benefits payments, and lost economic productivity [Ref. 5] (Cochrane Protocol, see Evidence).  It is estimated that up to 25% of all care home residents in the USA and in the UK have had a stroke. Stroke survivors who reside in care homes are likely to be more physically and cognitively impaired and therefore more dependent than those able to remain in their own home. Overall, 75% of care home residents are classified as severely disabled, and those with stroke are likely to have high levels of immobility, incontinence and confusion, as well as additional co‐morbidities [Ref. 6]. Evidence is needed to understand how this group of most severely affected stroke patients can be supported to recover abilities and lead a good quality of life.

Ref 5: National Audit Office 2010
Ref 6: Fletcher-Smith et al, 2013, Occupational therapy for care home residents with stroke, Cochrane https://doi.org/10.1002/14651858.CD010116.pub2
Evidence

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013317/full
Health Research Classification System category Stroke
Extra information provided by this PSP
Original uncertainty examples Please can you do some research about giving more therapy for people that are living in a nursing home? My wife had a bad stroke affecting her faculties and she doesn't get any physio in the home. She desperately needs more physio to help her but they say they don't provide physio in the home as there isn't much benefit. ~  What help is available for those severely affected by stroke, that are in nursing homes?  Rehab and therapy could continue but this type of on-going care seems very limited and nursing homes are unaware of what can be done.  A person surviving two years from severe stroke and still making small improvements is restricted by lack of knowledge.  
Submitted by Carer x 6, Health/social care professional x 8
PSP information
PSP unique ID 0106
PSP name Stroke Rehabilitation and Long-term Care
Total number of uncertainties identified by this PSP. 93  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 19/20th April 2021