Overview, Methods and Knowledge Exchange
6th Edition 2016-2018 UPDATE
The Canadian Stroke Best Practice Recommendations (CSBPR) are intended to provide up-to-date evidence-based guidelines for the prevention and management of stroke, and to promote optimal recovery and reintegration for people who have experienced stroke (patients, families and informal caregivers). The CSBPR are under the leadership of the Heart and Stroke Foundation, Canada (HSF) and involves over 200 volunteers from across Canada and internationally who have stroke expertise or who have been affected by stroke.
The CSBPR provide a common set of guiding principles for stroke care delivery, and describes the infrastructure necessary at a system level, and the clinical protocols and processes that are needed to achieve and enhance integrated, high-quality, and efficient stroke services for all Canadians. Through the innovations embodied within the stroke best practices, these guidelines contribute to health system reform in Canada and internationally.
The target audience for these recommendations includes all healthcare providers from a range of health disciplines who are involved in the planning, delivery and monitoring of quality stroke care.
Heart & Stroke works closely with national and provincial stakeholders and partners to develop and implement a coordinated and integrated approach to stroke prevention, treatment, rehabilitation, and community reintegration in every province and territory in Canada. The goal of disseminating and implementing these recommendations is to promote and support evidence-based stroke care across Canada, increase capacity for stroke service delivery, reduce practice variations in the care of stroke patients, and to reduce the gap between current knowledge and clinical practice.
The Canadian Stroke Best Practice Recommendations are developed and presented within a continuous improvement model and are written for health system planners, funders, administrators, and healthcare professionals, all of whom have important roles in the optimization of stroke prevention and care and who are accountable for results. A strong stroke research literature base is drawn upon to guide the optimization of stroke prevention and care delivery. Several implementation tools are provided to facilitate uptake into practice and are used in combination with active professional development programs. By monitoring performance, the impact of adherence to best practices is assessed and results then used to direct ongoing improvement. Recent stroke quality monitoring activities have compelling results which continue to support the value of adopting evidence-based best practices in organizing and delivering stroke care in Canada.
The Canadian Stroke Best Practice Recommendations development and update process is guided by a core set of principles which are applied to all activities of the writing groups. These principles state that all recommendations included in the CSBPR must be:
- Supported by high quality evidence and/or strong consensus that they are essential drivers to delivering high-quality stroke care;
- integral to facilitating health system improvement;
- aligned with other stroke-related Canadian best practice recommendations, e.g., the management of hypertension, diabetes, and dyslipidemia to decrease ambiguity and contradictions for front-line clinicians;
- reflective, in their totality, of the full continuum of stroke care.
The methodology for updating the recommendations includes twelve distinct steps to ensure a thorough and rigorous process. The detailed methodology and steps in the development and dissemination of the Canadian Stroke Best Practice Recommendations is available in the Canadian Stroke Best Practice Recommendations Overview and Methodology manual.
Updates and Revisions:
The Canadian Stroke Best Practice Recommendations undergo a thorough formal review and update of each chapter every two to three years. The CSBPR were first introduced in 2006, and subsequently updated and expanded in 2008, 2010, 2012 and 2015. The 2016 – 2018 update cycle is in the final completion stages, and the 2019 – 21 cycle was launched in January 2019.
Since research evidence for stroke care delivery is very dynamic and evolving, a protocol has been established to address late-breaking evidence in a timely way. When new evidence is released that may have an impact on any recommendations contained within these guidelines, the appropriate writing group is contacted and the evidence is reviewed, and decisions made regarding its impact on current recommendations. Any proposed revisions proceed through the same rigorous review process that is followed for the full chapter reviews. The CSBPR team then releases an interim bulletin regarding any off-cycle revisions that have been approved. These bulletins are incorporated into subsequent updates as applicable.
The CSBPR are made possible through the leadership of Heart and Stroke in collaboration with the Canadian Stroke Consortium and an extensive list of volunteers on our advisory committee and writing groups. These volunteers include people who are recognized leaders in the field of stroke care delivery, epidemiology, guideline development, systems change, and people who have experienced a stroke first hand or as a caregiver to someone who has had a stroke. All members of the CSBPR advisory committee and writing groups are required to complete declarations of conflict of interest prior to participation.
Current members of the Canadian Stroke Best Practices and Quality Advisory Committee are available here.
Current members of the CSBPR writing groups are available here.
- The human cost of stroke is immeasurable.
- Every year, approximately 62,000 people with ischemic stroke, hemorrhagic stroke and transient ischemic attack (TIA) are treated in Canadian hospitals.
- It is estimated that for each symptomatic stroke, there are nine covert strokes that result in vascular cognitive impairment – that can range from subtle changes in cognitive function and processes to severe vascular dementia.
- Stroke and other cerebrovascular diseases are the third leading cause of death in Canada.
- Stroke is the leading cause of adult disability, with over 405,000 Canadians living with the effects of stroke.
- About 60% of stroke patients are left with some disability and more than 40% are left with moderate to severe disability that requires more intense rehabilitation and support in the community. In Canada, 19% of people with stroke accessed inpatient rehabilitation services in 2016 and 10% were admitted to long-term care.
- 1.9 million brain cells die every minute during a stroke.
- The annual cost of stroke is approximately $3.6 billion, taking into account both healthcare costs and lost economic output.
- Although there are many proven interventions for stroke prevention, treatment and rehabilitation, they are not widely or consistently applied.
- In Canada there are more than 10,000 children (0 – 18 years) living with stroke.
This theme stresses the importance of integration and coordination across the healthcare system to ensure timely and seamless care of stroke patients to optimize recovery and outcomes.
Involvement of individuals who have had a stroke, their families and caregivers, is paramount to collaborations and partnerships and emphasized a patient and family-centred approach to stroke care delivery.
Working with interprofessional stroke care team members, other vascular care groups, emergency medical services, community care providers, educators, researchers, health system funders, planners and managers, will strengthen our ability to reduce risk factor prevalence, incidence, morbidity, and mortality from stroke.
Individuals who experience a stroke often present with additional health conditions or issues, which increases the challenges and complexity of comprehensive stroke management. Partnerships and collaborations with healthcare providers from a range of specialties is imperative to ensure people with multimorbidities have optimal control of each condition, do not fall through the cracks, do not receive conflicting or contra-indicated treatments, and do receive support to navigate the healthcare system.
Partnerships and collaborations are also necessary to support stroke care in rural and remote settings where some basic stroke services may not be available. People experiencing a stroke in those regions may not have access to optimal treatment strategies, which may result in poorer outcomes.
This theme aligns with and supports the Heart and Stroke Foundation’s Promote Recovery mission priority and is included as part of each module for the 2016-2018 update of the Canadian Stroke Best Practice Recommendations.
Heart & Stroke leads professional education activities that target members of interdisciplinary healthcare teams and system leaders who care for people who experience a stroke. We provide learning opportunities that address stroke care delivery across the full continuum of care. Our core knowledge exchange activities include:
- Stroke Best Practices webinar series: regular webinars that focus on new updates to our recommendations and more deeply explore current evidence and practice on specific topics relevant to stroke. Presentations are delivered by experts to increase knowledge and support the implementation of stroke best practice recommendations. Webinars are recorded and archived. To access the list of upcoming webinars and archived recordings visit the SBP webinars page.
- Implementation resources – a range of quick reference resources, training programs and links to high quality knowledge exchange tools are available within each recommendation section and Heart & Stroke developed resources are available on the professional resources webpage. Resources to support people experiencing stroke and their families are available on the patient resources page.
- Canadian Stroke Congress –The Canadian Stroke Congress (CSC), co-hosted by the Heart and Stroke Foundation and the Canadian Stroke Consortium, is the premier stroke congress in Canada. The goals of the Canadian Stroke Congress are to provide a high-quality educational event that will increase capacity and capability for stroke care in Canada. Information regarding the Canadian stroke congress can be found on the events webpage.
- Clinical Update – The Heart & Stroke Clinical Update is a two-day learning event that enables participants to bring the latest clinical developments, guidelines and practical knowledge pertaining to the prevention, diagnosis, assessment and management of cardiovascular and cerebrovascular diseases to patient practice. Clinical update is designed for healthcare providers across the continuum of care who support and manage people with heart disease and conditions, stroke and vascular cognitive impairment within their practice, especially primary care health team members and community-based providers across all disciplines and specialty areas.
Activities of daily living: The basic elements of personal care such as eating, washing and showering, grooming, walking, standing up from a chair and using the toilet.
Activity: The execution of a task or action by an individual. Activity limitations are difficulties that an individual may have in executing activities
Agnosia: The inability to recognize sounds, smells, objects or body parts (other people’s or one’s own) despite having no primary sensory deficits.
Alternate level of care: A patient receiving an alternate level of care is one who has finished the acute care phase of treatment but remains in an acute care bed, awaiting placement in an alternate care setting (chronic care unit, home for the aged, nursing home, home care program, etc.). This classification occurs when the patient is admitted as a patient’s physician gives an order to change the level of care from acute care and requests a transfer for the patient. Sometimes a patient is admitted as a patient requiring an alternate level of care because alternate care is not available (Canadian Institute for Health Information Discharge Abstract Antiplatelet agents: Agents that inhibit platelet aggregation. These agents are used in the prevention of ischemic stroke in high-risk patients.
Aphasia: Loss of the inability to produce or comprehend language as a result of injury to specialized areas in the brain related to these functions, affecting the ability to speak, understand, or read and write.
Apraxia: Impaired planning and sequencing of movement that is not due to weakness, incoordination or sensory loss.
Assistive technology: Technology designed to help a patient with limitations to perform daily activities and social roles.
Atrial fibrillation: Rapid, irregular beating of the heart.
Balance: Acquisition and maintenance of postural stability at rest or during activities.
Balance training: Sensory motor and cognitive intervention to promote postural stability.
Biofeedback: A technique monitoring physiological functions and providing extrinsic feedback, which may include somatosensory, visual and auditory input.
Canadian Institute for Health Information: An independent, not-for-profit organization that provides essential data and analysis on Canada’s health system and the health of Canadians. This organization tracks data in many areas, using information supplied by hospitals, regional health authorities, medical practitioners, governments and other sources.
Canadian Stroke Strategy: A joint initiative of the Canadian Stroke Network and the Heart and Stroke Foundation of Canada. It brings together a multitude of stakeholders and partners with the common vision that “All Canadians have optimal access to the integrated high quality, and efficient services in stroke prevention, treatment, rehabilitation and community reintegration”.
Cardio Respiratory Fitness: Related to the ability to perform large muscle, dynamic, moderate-to-high intensity exercise for prolonged periods. Improvements in cardiorespiratory fitness result in improvements of the heart to deliver oxygen to the working muscles and in the muscle`s ability to generate energy with oxygen and result in better endurance performance. (America College of Sports Medicine Guidelines, 2000)
Carotid endarterectomy: Surgical opening in one of the main neck arteries (the carotid arteries) performed when the artery is partially blocked by plaque (the buildup of fatty materials, calcium and scar tissue that narrows the artery). The procedure helps prevent a first stroke or reduces the risk of further strokes. It works best for people whose artery is narrowed but not completely blocked. (Heart and Stroke Foundation)
Cognitive: Relating to the ability to think, remember and solve problems.
Community-based rehabilitation therapy: Rehabilitation provided in the home or community-based organizations.
Community reintegration: A return to participation in desired and meaningful activities of daily living, community interests and life roles following a stroke event. The term encompasses the return to mainstream family and active community living and continuing to contribute to one’s social groups and family life. Community reintegration is a component in the continuum of care after stroke; rehabilitation helps clients identify meaningful goals for community reintegration and, though structured interventions, facilitates resumption of these activities to the best of their abilities. The stroke survivor, family, friends, stroke recovery associations, rehabilitation programs and the community at large are all integral to successful community reintegration.
Comorbid condition: Relates to the effect of all other diseases or conditions a patient may have in addition to the primary disease of interest
Compensatory therapy: Adaptive therapeutic interventions designed to enhance activity and participation (the focus is on function and not impairment).
Comprehensive stroke centres: Centres with specialized resources and personnel available at all times (24 hours a day, 365 days a year) to provide assessment and management of stroke patients. These facilities have established written protocols for emergency services, in-hospital care and rehabilitation; the ability to offer thrombolytic therapy to suitable ischemic stroke patients; timely neurovascular imaging and expert interpretation; and coordinated processes for patient transition to ongoing rehabilitation, secondary prevention and community reintegration services. Comprehensive stroke centres also include neurosurgical facilities and interventional radiology services. Comprehensive stroke centres have a leadership role in establishing partnerships with other local hospitals for supporting stroke care services. Comprehensive stroke centres should also have a performance measurement system in place to monitor the quality of stroke care and patient outcomes.
Computed tomography scan: Radiographic images of the head, appearing as a series of thin slices showing details of the brain`s anatomy. In some cases, a contrast dye may be injected to better define tissues and blood vessels and enhance the images. These images can show whether a stroke was due to a blood clot (an ischemic stroke) or uncontrolled bleeding (a hemorrhagic stroke). This is often one of the first tests scheduled for someone who has had a stroke.
Constraint induced therapy: Intervention designed to enhance recovery of function or a body part by restraining a less affected function or body part.
Continuing Care Reporting System: Contains standardized clinical and administrative information on continuing care in Canada, which includes detailed clinical, functional and service information (e.g., residents` preferences, needs and strengths) and provides a snapshot of the services they use. Two types of facilities are included: hospitals that have beds designated and funded as continuing care beds, commonly known as extended, auxiliary, chronic or complex beds; and residential care facilities, commonly known as nursing homes, personal care homes or long-term care facilities. The data are collected using the Resident Assessment Instrument (RAI) Minimum Data Set (MDS 2.0).
Conventional therapy: The usual care offered in a particular setting and must be defined in terms of their intensity, frequency, and duration.
Day hospital: A defined geographic outpatient unit dedicated to interdisciplinary care and rehabilitation of an individual.
Deep vein thrombosis: Thrombosis (a clot of blood) in the deep veins of the leg, arm or abdomen.
Disability: A defect in performing a normal activity or action (e.g., inability to dress or walk).
Discharge Abstract Database: Database of information related to acute care hospital discharges across Canada. The database is maintained by the Canadian Institute for Health Information, which receives data directly from all hospitals in every province and territory except Quebec. The database contains demographic, administrative and clinical data for hospital discharges (inpatient acute, chronic, rehabilitation) and day surgeries in Canada.
Discharge disposition: A patient`s destination following a visit to the emergency department or following a stay in hospital. A patient`s discharge disposition may or may not be the same location as before their visit to hospital.
Dysarthria: Impaired ability to produce clear speech due to the impaired function of the speech muscles
Dysphagia: An impairment of swallowing that may occur following a stroke.
Early supported discharge: Early supported discharge services aim to move forward the time of discharge from hospital, as well as to provide a more continuous process of rehabilitation spanning both the period in hospital and the first few weeks at home. In these two ways, early supported discharge alters the conventional pathway of care to ensure more amenable services for patients undertaking rehabilitation.
Emergency department: A hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention.
Emergency medical services: Provide out-of-hospital acute care and transport to definitive care for patients with illnesses and injuries that the patient believes constitute a medical emergency. The most common and recognized type of emergency medical service is an ambulance or paramedic organization.
Enteral tube: Delivery of nutrients directly into the digestive system via a tube.
Executive function: Cognitive functions usually associated with the frontal lobes, including planning, reasoning, time perception, complex goal-directed behaviour, decision-making and working memory.
Exercise therapy: Intervention directed towards optimizing physical capacity.
Functional independence measure: An 18-item, 7-level ordinal scale. It is the product of an effort to resolve the long-standing problem of lack of uniform measurement and data on disability and rehabilitation outcomes.
Gait: The pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Hemiparesis: Weakness involving one side of the body (of mild, moderate or severe degree) that may be caused by stroke, and can be accompanied by sensory or other neurological deficits.
Hemiplegia: Refers to a complete paralysis. Complete loss of motor function on one side of body that may be caused by stroke localized to the cerebral hemisphere opposite to the side of weakness.
Hemorrhagic stroke: A stroke caused by the rupture of a blood vessel within the brain, usually an artery.
Hyperacute period: The time frame from the initial onset of stroke symptoms and engagement of emergency medical services though interaction with paramedics and within the emergency departments of acute care hospitals.
Hypertension: High blood pressure, defined as a repeatedly elevated blood pressure exceeding 140 ⁄ 90 mm HG. Hypertension is a risk factor for stroke or transient ischemic attack and is managed with regular aerobic exercise, weight reduction (if overweight), salt reduction and medications.
Hypertonia: Abnormal increase in resistance while externally imposing movement about a joint.
Impairment: A problem in the structure of the body (e.g., loss of a limb) or the way the body of a body part functions (e.g., hemiplegia).
Infarction: Death of cells in an organ (e.g., the brain or heart) due to lack of blood.
Integration: An integrated health system would result in coordinated health services that both improve accessibility and allow people to move more easily through the care and treatment continuum of the care health system and would provide appropriate, effective and efficient health services.
Intensity: The level of effort demanded or required of the individual in relation to their current capacity (physical and mental)
Interdisciplinary stroke team: A comprehensive team of healthcare professionals who are dedicated to the care of stroke patients within a unit. An interdisciplinary stroke team may include persons who have experienced a stroke, family and caregivers, neurologists and other physicians with expertise in stroke management, physiatrists, nurses, primary care practitioners, physical therapists, occupational therapists, speech language pathologists, social workers, dieticians, pharmacists, psychologists, rehabilitation assistants and pastoral care workers.
International normalized ratio: Used to evaluate the ability of blood to clot properly, this ratio can be used to assess both bleeding and clotting tendencies. One common use is to monitor the effectiveness of anticoagulants such as warfarin.
Ischemia: An inadequate flow of blood to part of the body because of blockage or constriction of the arteries that supply it.
Last seen normal: The date and time a patient was last known to be normal before the onset of symptoms of stroke or transient ischemic attack.
Lack of stay: A measure of the duration of a single hospitalization.
Length of stay: A measure of the duration of a single hospitalization.
Long-term care home: A facility that provides rehabilitative, restorative or ongoing skilled nursing care to residents in need of assistance with activities of daily living.
Low-density lipoprotein: A compound that regulates cholesterol synthesis from the liver to the peripheral tissues. Sometimes referred to as “bad cholesterol,“ LDL may put an individual at risk for cerebrovascular disease if it occurs at high levels.
Mean: Simple average, equal to the sum of all values divided by the number of values.
Median: The value that has 50 percent of the data points above it and 50 percent below it.
Medical redirect bypass: Following predefined medical criteria and a written agreement between physicians, hospitals, dispatch and ambulance service, a closer hospital may be bypassed for medical reasons to redirect the person exhibiting signs and symptoms of stroke to a stroke centre that can provide expert timely assessment and treatment
Muscular endurance: Ability of a muscle or muscle group to perform repeated muscle contractions over a period of sufficient to cause muscular fatigue, or to maintain a specific percentage of the maximum voluntary contraction for a prolonged period of time (ACSM, 2001)
Muscle strength: Maximal force that can be generated by a specific muscle or muscle group. (ACSM, 2000)
National Ambulatory Care Reporting System: Includes data for all hospital-based ambulatory care provided departments. Client visit data are collected at the time of service in participating facilities. Currently, data submission to the National Ambulatory Care Reporting System has been mandated in Ontario for emergency departments, day surgery units, dialysis units, cardiac catheterization suites and oncology units (including all regional caner centres). Data elements include demographic data, clinical data, administrative data, financial data and service-specific data elements for day surgery and emergency.
National Rehabilitation Reporting System: Includes client data collected from participating adult inpatient rehabilitation facilities and programs across Canada. Data are collected at time of admission and discharge by service providers in participating facilities. There is also an optional postdischarge follow-up data collection process. The National Rehabilitation Reporting System data elements are organized under the following categories: socio-demographic information, administrative data (e.g., referral, admission and discharge), health characteristics, activities and participation (e.g., activities of daily living, communication, social interaction), interventions. These elements are used to calculate a variety of indicators including wait times and client outcomes.
Neglect: The failure to attend or respond to or make movements toward one side of the environment.Outpatient rehabilitation: Includes day hospital, outpatient ambulatory care and home-based rehabilitation. Outpatient therapy in the subacute phase of stroke (4 to 8 weeks after stroke) is often prescribed following discharge from inpatient stroke rehabilitation units. (Evidence-Based Review of Stroke Rehabilitation, 10th edition)
Outpatient Therapy: In the subacute phases of stroke (4-8 weeks after stroke) outpatient rehabilitation therapy in an outpatient clinic affiliated with an acute care or inpatient rehabilitation facility may be prescribed upon discharge from acute inpatient care or inpatient rehabilitation.
Percutaneous endoscopic gastrostomy: A form of enteral feeding in which nutrition is delivered via a tube that has been surgically inserted into the stomach through the skin.
Performance measure: A quantifiable measure of outcomes, outputs, efficiency, access and other dimensions of quality of care.
Pulmonary embolism: Blockage of the pulmonary artery (which carries blood from the heart to the lungs) with a solid material, usually a blood clot or fat, that has travelled there via the circulatory system.
Rankin Scale (modified): An outcomes scale used to measure disability or dependence in activities of daily living in stroke victims.
Recovery: The process whereby the person regains body structure, function, activity and participation. (Not time limited)
Registry of the Canadian Stroke Network: A clinical database that collects data from prehospital stroke onset to discharge from acute care, following a stroke or transient ischemic attack. Information is collected on risk factors, presentation, acute investigations and interventions, inpatient management, complication, discharge disposition, length of stay and mortality. Note: During the data collection period for the 2006 report of the Stroke Evaluation Advisory Committee, only 10 regional stroke centres were participating in the Registry of the Canadian Stroke Network (Central South ⁄ Royal Victoria Hospital was not yet part of the network). Data collection began July 1, 2003, so the fiscal year 2003-04 included only 9 months of data, which means that volumes and counts are underestimated for that year.
Rehabilitation: Restoration of a disabled person t optimal physical and psychological functional independence.
Restorative (remedial) therapy: Therapeutic interventions designed to restore body structure and function by targeting the underlying impairment to enhance recovery.
Risk factor: A characteristic of a person (or group of people) that is positively associated with a particular disease of condition.
Spasticity: Velocity-dependent increase in muscle tone that often occurs in stroke.
Stroke: Rapidly developing clinical signs of focal (at times global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.
Stroke prevention clinic: A clinic providing comprehensive stroke prevention services to patients who are not admitted to the hospital at the time of their emergency department visit. Prevention clinics offer an interdisciplinary team approach and are typically funded for an advanced practice nurse, a medical secretary and a behavioural psychologist or occupational therapist.
Stroke unit: A specialized, geographically located hospital unit with a dedicated stroke team and stroke resources (e.g., care pathway, educational material, monitored beds). The unit does not need to have all of these resources, nor does it have to be exclusive for stroke patients, but it must be in one location.
Subarachnoid hemorrhage: Occurs when a blood vessel just outside the bran ruptures and blood fills the subarachnoid space surrounding the brain, Symptoms may include a sudden, intense headache, neck pain, and nausea or vomiting,
Task-specific training: Training that involves repetition of a functional task or part of the task.
Telemedicine/telestroke: Use of electronic communication to exchange medical information from one site to another to educate the patient or the healthcare provider, and to improve patient care and health.
Thrombolytics: An agent (medication) that dissolves or splits up a blood clot.
Tissue plasminogen activator: A clot-busting drug used to treat heart attack and ischemic stroke.
Tone: Resistance to passive stretch while the patient is attempting to maintain a relaxed state of muscle activity.
Transient Ischemic attack: A brief episode of neurological dysfunction cause by focal brain, spinal cord or retinal ischemia, with clinical symptoms and without imaging evidence of acute infarction. TIA and minor stroke are a continuum that cannot be differentiated by symptom duration alone, but the former typically resolves within one hour.
Vascular cognitive impairment: A common form of dementia that is due to cerebrovascular disease. Symptoms include confusion, memory problems, loss of bladder or bowel control (incontinence), emotional problems such as inappropriate laughing or crying, difficulty following instructions and problems with daily activities such as handling money
AAC Augmentative and alternative communication
ADL Activities of daily living
ASA AcetylsalicylicAcid (aspirin)
CEMRA Contrast enhanced magnetic resonance angiography
CHEP Canadian Hypertension Education Program
CSN Canadian Stroke Network
CSS Canadian Stroke Strategy
CT Computed tomography
DBP Diastolic Blood Pressure
DM Diabetes Mellitus
DVT Deep vein thrombosis
EBRSR Evidence-Based Review of Stroke Rehabilitation
ED Emergency Department
EMS Emergency Medical Services
ESD Early supported discharge
EWG Expert Working Group
GP General Practitioner
ICH Intracranial hemorrhage
ICU Intensive care unit
INR International normalized ratio
IPC Intermittent pneumatic compression
LDL Low-density Lipoprotein
LMWH Low molecular weight heparin
MCA Middle cerebral artery
MI Myocardial Infarction
MR-DWI Magnetic resonance diffusion weighted imaging
MRI Magnetic Resonance Imaging
NINDS National Institute of Neurological Disorders and Stroke
NNT Numbers needed to treat
OBS Observational study
OT Occupational therapist
PE Pulmonary embolism
PEG Percutaneous endoscopic gastrostomy
PT Physical therapist or Physiotherapy
RCT Randomized controlled trial
rFVIIa recombinant activated factor VII
rt-PA Recombinant tissue plasminogen activator
RN Registered nurse
RRR Relative risk reduction
SAH Subarachnoid Hemorrhage
SCORE Stroke Canada Optimization of Rehabilitation through Evidence
SBP Systolic Blood Pressure
SLP Speech Language Pathologist
SR Systematic review
STAIR Stroke transition after inpatient care
STEP Stroke Therapy Evaluation Program
SU Stroke Unit
SW Social work or Social worker
TIA Transient ischemic attack
tPA Tissue plasminogen activator
TTE Transthoracic echocardiography
TEE Transesophageal echocardiography
UK United Kingdom
UFH Unfractionated heparin
VTE Venous Thrombus Embolism