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Telestroke leads new additions to living guidelines

Recommendations for the use of telehealth feature in the latest updates to the Clinical Guidelines for Stroke Management approved in December 2021 by the National Health and Medical Research Council (NHMRC). Other updates cover pre-hospital identification of stroke, management of head position in hospital, preventing further strokes through surgery and risk factor modification, rehabilitation of arm activity and memory, and prevention and management of swelling of the extremities.

Telestroke services are used in acute stroke treatment to help assess patients for thrombolysis and transfer for endovascular therapy, where 24/7 onsite specialists are unavailable. They greatly increase equity of access to these vital services in regional or rural settings, which is why our Content Working Group decided they should be strongly recommended.

Separately, telehealth services may be used in rehabilitation too, as an adjunct to in-person therapy or an alternative for patients who cannot access specialist rehab in the community. These services proved particularly valuable as access was restricted during the COVID-19 pandemic (for more on these services, see our Telerehab page).

The other changes in this latest round of updates are:

  • Pre-hospital care (Chapter 1) – New practice point for regular education to help clinicians identify stroke patients.
  • Head position (Chapter 3) – New topic with recommendation that any position may be used in the first 24 hours after hospital admission, while in bed and not receiving nasogastric feeding.
  • Management of atrial fibrillation (Chapter 4) – Closing off the opening to the left atrial appendage may be reasonable when long-term anticoagulation is not possible.
  • Lifestyle modifications (Chapter 4) – Everyone who has had a stroke or TIA may be given interventions addressing secondary stroke risk factors, with support and counselling, reviews by health care professionals, and exercise training. Also, a new consensus recommendation for a Mediterranean or similar style diet, and referral to a dietitian for individualised advice.
  • Arm activity (Chapter 5) – Virtual reality and interactive games may now be used with any timing and duration, and independently of impairment severity.
  • Memory (Chapter 5) – Cognitive rehabilitation, including both internal strategies and external aids, may be used to improve memory function in the short term.
  • Swelling of the extremities (Chapter 6) – Passive mobilisation is now recommended for prevention and management, along with elevation of the limb when resting.
     

Links to these and previous changes, as well as additions to background evidence can be found in our Living guidelines updates.