Table 2 Examples of recommendations, Adopt–Contextualise–Adapt decisions (Fig. 1) and implementation plans [5]
Evidence strengtha,b | Recommendations | Endorsement | Implementation plans | |
|---|---|---|---|---|
1. | ✓✓✓ | There are consistent strong recommendations that people who suffer from stroke should be seen by a multidisciplinary/inter-professional/interdisciplinary stroke team for medical and rehabilitation assessment and management. The team consists of doctors, nurses, physiotherapists, occupational therapists, speech language therapists, social workers, dieticians, clinical neuropsychologists/clinical psychologists | B2 | Increase the rehabilitation workforce (requiring at least 5 years for students to graduate from new university programmes) Increase funding to support a multidisciplinary stroke workforce (requiring at least 2 years to lobby, plan and train) |
2. | ✓✓ | There are consistent suggestions that all members of the multidisciplinary team should have specialised training in stroke care and recovery | A2 | Increase the amount of tertiary training in rehabilitation in medical, nursing and allied health programmes (requiring a 2–3 year timeframe) |
3. | ✓✓✓ | There are consistent strong recommendations that all patients who suffer from stroke should have access to specialist stroke service units with multidisciplinary team as early as the hyperacute–acute stages of stroke and up to discharge | B2 | Same solutions as for 1, but including changing opinions of hospital administrators, policy-makers and funders about the value of specialist stroke service units |
4. | ✓✓✓ | There are consistent strong recommendations that rehabilitation should commence in the acute setting as soon as the person with stroke is medically safe and/or able to participate | A1 | There are no barriers to this, but it may be important to educate medical doctors to refer stroke suffers as quickly as possible for rehabilitation |
5. | ✓✓ | There are consistent suggestions that a standard set of assessment tools should be used to assess rehabilitation needs throughout the patient journey; these should be valid, sensitive to detect change, simple to use and, if required, apply standard protocols to assist more complex assessment | C2 | Current international assessment tools require further evaluation for local contexts and fit to South African rehabilitation settings Local tools dealing with local outcome issues may need to be developed |