Review of longer-term problems after a disabling stroke

Over the last three decades there has been a change in attitude to the care of patients after stroke from a somewhat nihilistic stance to a predominantly acute focus with potential for rehabilitation. More recently there has been a widening of perspective, with recognition that stroke is a long-term condition . Aligned with this has been a gradual shift in focus from a primarily biomedical approach to stroke care, to one that considers the psychological and social elements of the poststroke experience. However, the evidence base for stroke is still dominated by prevention and early-care treatments: only eight of the 238 recommendations reported in the UK national clinical guidelines for stroke specifically address longer-term management. The Australian clinical guidelines for stroke offer a similar pattern: 22 (14%) of 162 recommendations relate to community participation and organization of longer-term support. However, ongoing research efforts to develop and evaluate interventions for longer-term stroke care are beginning to address the imbalance in the evidence base. In our previous review, surveys reporting the types and prevalence of longer-term problems experienced after stroke were summarized and synthesized within a structured framework. The review demonstrated the complexity and diversity of the longer-term stroke experience, and highlighted the challenges that support services face in meeting the needs of patients and carers living with the aftermath of stroke. Keeping abreast with this challenging subject area is key to promoting the continued development of stroke services. This review is an update of our previous work, presenting the most recently published data on the prevalence of longer-term stroke-related problems.