Table 1 Response to survey 1 regarding importance of guideline recommendations for implementation

Ambulances should take patients with suspected stroke to a hospital that has a stroke unit and can perform thrombolysis or clot retrieval

10

63%

10

9.8

37

49%

10

9.7

Patients with stroke who could possibly benefit from thrombolysis (clot-busting) should be assessed by the stroke team in the emergency department, given a brain scan (CT or MRI) within 60 minutes, and if found to be eligible, given thrombolysis within 4.5 hours

9

56%

10

9.3

33

44%

10

9.7

A carotid artery scan should be given to any patients whose stroke could have been caused by a clot in their carotid arteries

1

6%

9.5

8.5

6

8%

9

8.9

All patients with stroke should be admitted to hospital and be treated in a stroke unit with an interdisciplinary team, made up of medical, nursing and allied health professionals

9

56%

10

9.6

32

43%

10

9.4

Antiplatelet medication (aspirin, clopidogrel or dipyridamole) should be given as soon as the stroke is determined to be a clot and not a bleed, and if the patient is not receiving thrombolysis or clot retrieval

1

6%

9

8.7

7

9%

8

8.3

Blood glucose should be monitored for the first 72 hours, and medication given if the glucose levels are too high

0

0%

8.5

8.6

0

0%

8

8.0

Blood pressure-lowering medication should be given or increased for all patients with stroke and TIA who have blood pressure over 140/90 mmHg, before they are discharged from hospital

2

13%

9.5

8.8

8

11%

8

8.1

Antiplatelet medication (aspirin, clopidogrel or dipyridamole) should be prescribed to all people with ischaemic stroke or TIA who are not taking anticoagulants

2

13%

9

8.4

9

12%

8

8.1

Oral anticoagulation medication (blood thinners) should be prescribed for patients with ischaemic stroke and TIA who have atrial fibrillation (irregular heartbeat)

2

13%

9

8.8

10

13%

9

8.6

All people with an ischaemic stroke or TIA that may have been caused by an artery blocked by cholesterol plaque should be prescribed statins

0

0%

8

7.6

2

3%

8

7.8

Early supported discharge, which links hospital rehab with services for community and home rehab, should be offered to patients with mild to moderate stroke, if the appropriate services are available

0

0%

9.5

8.8

16

21%

10

8.9

Recovery goals should be set together with the stroke survivor, their family or carer, and the stroke team. The goals should be well-defined, specific and challenging, clearly documented, and reviewed and updated regularly

3

19%

9

8.8

13

17%

9

8.6

Out-of-bed activities should start within 48 hours of a patient's stroke, unless it is inappropriate (e.g. due to a patient being under palliative care)

3

19%

8

8.1

10

13%

9

8.5

Stroke survivors who have trouble walking should be given as many chances as possible to practice their walking repetitively and tailored to their needs

2

13%

9

8.4

8

11%

9

8.5

Constraint-induced movement therapy, in which someone's good hand is restrained so they have to use their affected hand, should be given to stroke survivors with some ability to move their wrists and fingers. It should involve a minimum of 2 hours of active therapy per day for 2 weeks, plus restraint of the good hand for at least 6 hours per day. A harness can also be used during therapy to restrain their torso

1

6%

6

6.6

2

3%

7

6.6

Stroke survivors who live at home and have trouble with their daily activities should be assessed by a trained clinician and given therapy, e.g. practising specific tasks and training to use aids and equipment

0

0%

8

8.1

10

13%

9

8.7

Speech and language therapy should be given to stroke survivors with aphasia, to improve their ability to communicate their wants and needs

3

19%

10

8.9

10

13%

9

8.9

All patients with stroke should be assessed and monitored for hydration problems, i.e. dehydration or over-hydration, and managed if necessary

0

0%

8

7.8

1

1%

8

8.3

Patients with stroke should be screened for malnutrition when first admitted and again at least every week while they are in hospital, with nutritional supplements given if they need them

0

0%

7.5

7.4

1

1%

7

7.3

Antidepressants should be considered for stroke survivors with symptoms of depression

0

0%

8

8

4

5%

8

8.1

All stroke survivors, their family and carers should be offered information that suits their individual needs and their language or communication requirements

5

31%

10

9.3

14

19%

10

9.2

A comprehensive discharge care plan that addresses the patient's specific needs should be developed together with them and their carer before they are discharged from hospital

3

19%

9.5

8.4

22

29%

10

9.1

Carers should be given tailored information and support at all stages of recovery, including opportunities to talk with the relevant health professionals about the stroke, what the stroke team does, test results, treatment and discharge plans, community services and contact details. It can be given before discharge or in the home, and can be face-to-face, over the phone or online

4

25%

9.5

8.5

15

2%

10

8.8