Stroke Scales and Trajectory of Recovery: A Major Concern for Patients and Nurses Alike

Introduction: Stroke recovery is a major issue of concern for the surviving patient and family but its rate varies from person to person. Existing prognostic models for stroke recovery are commonly based on stroke level of neurological deficit on admission.

Aim: The aim of this discussion paper was to review stroke progression and analyse the trajectory of stroke recovery. It also addressed the value of using standardized neurological assessment tools in routine stroke care and the integration of easy to use assessment tools into everyday nursing practice.

Methods: Medline and Google Scholar databases were searched using combinations of the following keywords: scale, stroke, rehabilitation and nursing from 2000 onwards.

Results: Popular scales used in stroke practice and research, including attempts to evaluate patient progress after stroke can be divided as follows: i) Neurological deficit scales ii) Functional outcome iii) Global outcome scales iv) Health related quality-of-life scales. The assessment tools for discussion in this paper are the Scandinavian Stroke Scale (SSS) the Barthel Index of daily living (BI) and the modified Rankin Scale (mRS). All three measures are well established in the international literature as reliable and valid of stroke outcomes and have been used in numerous large scale studies. Due to the diversity of available outcome measures for acute stroke choosing one tool is challenging and using more than one scale implies that the scales are imperfect. Yet, consistent and routine use of validated and standardized tools for neurological and functional assessment of stroke survivors in conduction with well established treatments and management guidelines complement effective patient care.

Conclusions: This paper argues that despite barriers to routine use of stroke scales as reported by some nursing staff, particular efforts should be made in nurse training to introduce and demonstrate the importance of stroke scales. Their use not only provides a reliable record of progress but also contributes to optimum patient care and outcomes.

Author(s): Dimitrios Theofanidis, Xenophon Fitsioris and Tsiptsios Iakovos

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