We agree with the comments of Drew Dawson and colleagues. In fact, organized care in an inpatient stroke unit — which includes early mobilization and rehabilitation — is the first key indicator in our paper1 and is effective in improving outcomes after stroke.1,2 We recognize that there is an overemphasis in the literature on hyperacute stroke treatments relative to the benefits of several rehabilitation therapies, which apply for the majority of stroke survivors.
The Canadian Stroke Quality of Care Study, from which the acute care indicators emerged, is an ongoing multiphase study. Our goal is to build a comprehensive evaluation framework that measures patients' access to appropriate stroke care, according to their particular symptoms, as well as the flow of patients receiving such care. This model will include indicators that reflect care within each sector along the continuum of care; more importantly, the current work will build the critical indicators reflecting true integration between the points along the continuum, including transition from acute care to rehabilitation, and from rehabilitation to community care and recovery.
We and many other researchers are at work on the development of stroke rehabilitation indicators. This research suggests that tools such as the Functional Independence Measure, the Barthel Score and the Orpington Score may be used to facilitate referral and to measure the transition between acute care and rehabilitation, but the ideal tools for tracking patients from inpatient care into the community are still unclear.
References
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