Development of a National Protocol for Stroke Rehabilitation in a Multicenter Italian Institution
Condition: Stroke; Rehabilitation
MeSH terms: Stroke
Study type: Observational

Summary: 
      Due to the importance to use standardized shared protocols in the rehabilitative setting of
      cerebrovascular diseases, an harmonization and redefinition of the Don Carlo Gnocchi
      Foundation rehabilitative model was carried out. Such process was in line with the Evidence
      Based approach of Cochrane Rehabilitation.
    

Detailed description: 
      Despite progress in the treatment of cerebrovascular diseases in the acute phase, stroke
      remains a catastrophic event with important public health consequences. According to the most
      recent ASA/AHA guidelines, a specific and intensive rehabilitation is recommended in patients
      with neurological impairments after stroke in the postacute phase.

      In this regard, the use of standardized shared evaluation protocols, developed according to
      the ICF model is strongly recommended to evaluate the effectiveness of rehabilitative
      treatments on large populations of stroke patients affected and, possibly, to allow the
      identification of biomarkers, identifiable in the acute phase and in the immediate post-acute
      period, to predict prognosis and to orient rehabilitation care.

      The Don Carlo Gnocchi Foundation ONLUS is one of the most important health groups in Italy,
      with over 3,700 beds and 28 Centers, active in 9 Italian regions (Northern, Central and
      Southern Italy). The don Gnocchi Rehabilitation Hospitals are accredited by the different
      Regional Health Services all over Italy.

      During 2016 and based on 60 years of experience, an harmonization and redefinition of the
      Foundation rehabilitative model was carried out. Such process was in line with the Evidence
      Based approach of Cochrane Rehabilitation.

      The Medical Committee was the first step for the national identification of a group of health
      professionals which includes, in addition to MD specialists, all health professions involved
      in Interdisciplinary Rehabilitation Team.

      The first objective was to develop consensus over national Rehabilitation protocols for the
      most prevalent conditions addressed to in our Rehabilitation Hospitals. Given the prevalence
      of neurological rehabilitation treatments and in particular Stroke, the Medical Direction
      appointed a group of 6 Specialists, who entrusted the task of developing a Stroke
      rehabilitation don Gnocchi Protocol.

      The study describes the method and the criteria used in the development of the protocol, the
      steps followed in its implementation in two Don Gnocchi Foundation Pilot Hospitals, and the
      preliminary results of the pilot study, limited to the treatment of intensive post-acute
      inpatient rehabilitation, with the objective of verifying the feasibility of the protocol and
      comparing the outcomes for stroke inpatient rehabilitation with those of the 3 years prior to
      implementation.
    

Intervention name(s): Rehabilitative intervention
Intervention type(s): Other
Intervention description(s): intensive multidisciplinar rehabilitation
Observational model: Other
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        443 patients all patients with stroke accessing the Don Gnocchi Rehabilitation facility of
        Marina di Massa and Fivizzano, by authorization of the local public health authority
        specialists in Physical Medicine and Rehabilitation were enrolled.
      
Keywords: Stroke; Rehabilitation; Protocol; Evidence-based