Assessments in Australian stroke rehabilitation units: a systematic review of the post-stroke validity of the most frequently used

Abstract

Purpose. In Australia, stroke is the leading cause of adult disability. For most stroke survivors, the recovery process is challenging, and in the first few weeks their recovery is supported with stroke rehabilitation services. Stroke clinicians are expected to apply an evidence-based approach to stroke rehabilitation and, in turn, use standardised and validated assessments to monitor stroke recovery. In 2008, the National Stroke Foundation conducted the first national audit of Australia's post acute stroke rehabilitation services and findings identified a vast array of assessments being used by clinicians. This study undertook a sub-analysis of the audit's assessment tools data with the aim of making clinically relevant recommendations concerning the validity of the most frequently selected assessments.

Method. Data reduction ranked the most frequently selected assessments across a series of sub-categories. A serial systematic review of relevant literature using Medline and the Cumulative Index to Nursing and Allied Health Literature identified post-stroke validity ranking.

Results. The study found that standardised and non-standardised assessments are currently in use in stroke rehabilitation. It recommends further research in the sub-categories of strength, visual acuity, dysphagia, continence and nutrition and found strengths in the sub-categories of balance and mobility, upper limb function and mood.

Conclusions. This is the first study to map national usage of post-stroke assessments and review that usage against the evidence. It generates new knowledge concerning what assessments we currently use post stroke, what we should be using and makes some practical post stroke clinical recommendations.

Keywords:

• Stroke
• stroke rehabilitation units
• assessment

Acknowledgements

The authors gratefully acknowledge the 97 hospitals and their dedicated staff that contributed time and effort to provide the data to the National Stroke Audit. Acknowledgements are also due to the National Stroke Foundation for providing access to these data for this study and to the experts that provided advice during consultation.

Declaration of interest:

The authors report no declarations of interest.