[ARTICLE] Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce – Full Text

Abstract

The first Stroke Recovery and Rehabilitation Roundtable established a game changing set of new standards for stroke recovery research. Common language and definitions were required to develop an agreed framework spanning the four working groups: translation of basic science, biomarkers of stroke recovery, measurement in clinical trials and intervention development and reporting. This paper outlines the working definitions established by our group and an agreed vision for accelerating progress in stroke recovery research.

Introduction

The first Stroke Recovery and Rehabilitation Roundtable (SRRR) was convened with the aim to move rehabilitation research forward.¹ Working collectively across four initial priority areas, we reviewed, discussed, and attempted to achieve consensus on key recommendations in each of the areas of translation of basic science,² biomarkers of stroke recovery,³ measurement in clinical trials⁴ and intervention development and reporting.⁵ Agreed definitions were a priority. Definitions within stroke recovery research are particularly complex given both the extended time window over which research, clinical interventions and recovery take place; and the multi-disciplinary, multi-faceted nature of the field. This paper outlines the working definitions established by our group that underpinned the scope and methodologies of each of the four groups. Agreed priority areas for accelerating progress in stroke recovery research are highlighted as a way forward for the field. These were developed following comprehensive discussions at the first SRRR roundtable meeting convened in Philadelphia, 2016.

A major point of agreement of the SRRR expert group was to focus on progress of stroke recovery research in the next decade and beyond. ‘Rehabilitation’ as a blanket term for all therapy-based interventions post-stroke was considered problematic, vague and an impediment to progress. Rehabilitation reflects a process of care, while recovery reflects the extent to which body structure and functions, as well as activities, have returned to their pre-stroke state. With that, the term ‘recovery’ can be represented in two ways: (1) the change (mostly improvement) of a given outcome that is achieved by an individual between two (or more) timepoints, or (2) the mechanism underlying this improvement in terms of behavioural restitution or compensation strategies.^6,7 We used the definition of rehabilitation developed by the British Society of Rehabilitation Medicine,⁸ “a process of active change by which a person who has become disabled acquires the knowledge and skills needed for optimum physical, psychological and social function.” Stroke rehabilitation is most often delivered by a multidisciplinary team, defined by the World Health Organisation (WHO)⁹ to encompass the coordinated delivery of intervention(s) provided by two or more disciplines in conjunction with medical professionals. This team aims to improve patient symptoms and maximise functional independence and participation (social integration) using a holistic biopsychosocial model, as defined by the International Classification of Functioning Disability (ICF).⁹

Continue —>  Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforceInternational Journal of Stroke – Julie Bernhardt, Kathryn S Hayward, Gert Kwakkel, Nick S Ward, Steven L Wolf, Karen Borschmann, John W Krakauer, Lara A Boyd, S Thomas Carmichael, Dale Corbett, Steven C Cramer, 2017

Figure 1. Framework that encapsulates definitions of critical timepoints post stroke that link to the currently known biology of recovery.