National clinical guidelines for stroke: a concise update.

The National Clinical Guidelines for Stroke (1) cover the management of stroke from the acute illness through to transfer of care from hospital to the community, to longer-term problems including carer support and secondary prevention. They are designed to be read by all health and social service professionals, including those working in primary care. Since the guidelines were first published there have been some major developments in stroke research. These have now been incorporated into an updated supplement to the guidelines (2). The new updates include: The recommendation that specialist stroke services should include a neurovascular clinic to enable patients with transient ischaemic attack (TIA) and minor stroke, (where the patient has not been admitted to hospital), to be investigated and treated within a maximum of two weeks. Changes in the recommendations about the management of blood pressure after stroke following the publication of the HOPE and PROGRESS trials. Although advances in therapy research do not warrant radical alterations to practice, two changes have been made. These recommend the use of resisted exercise to improve motor function in targeted muscles and that patients should be given as much opportunity to practice tasks as possible. More precise recommendations on the management of depression. The withdrawal of some recommendations concerning the management of shoulder pain, deep venous thromboses and biofeedback. With the research evidence evolving at a rapid rate a new version of the complete guidelines will be published in 2003.