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Introduction The Conference was arranged by the International Society of Internal Medicine (ISIM) and was organised and led by Thomas Kjellström, the president of ISIM. It was endorsed by the European Stroke Council (ESC) and International Stroke Society (ISS) and co-sponsored by the World Health Organization (WHO) Regional Office for Europe, and was in collaboration with the European Region of the World Confederation for Physical Therapy (ER-WCPT) and the European Association of Neuroscience Nurses (EANN) The ER-WCPT had the opportunity to review and make comments and recommendations to the revision of the 1995 Helsingborg Declaration on Stroke prior to the Conference. All the Member Organisations of the ER-WCPT were contacted and asked to contribute to the update of the Declaration. Several comments were received and two Organisations, the Chartered Society of Physiotherapy, UK, and the Legitimerade Sjukgymnasters Riksförbund, Sweden, sent comprehensive comments and recommendations that were used as a basis for the comments of the ER-WCPT. Purpose of the Conference: The purpose of the Conference was to propose a document for stroke management in five domains: organization of stroke services, outcome and quality assessment, management after acute stroke, rehabilitation and prevention. The draft document is a revision and update of the 1995 Helsingborg Declaration on Stroke. Participants / Speakers Approximately 130 participants from 24 countries attended the meeting, twenty three from Europe and one from Canada. The first Vice Chairman represented the ER-WCPT at the Conference. At the Conference there was consensus on the goals for 2015 on European Stroke Strategies: Organization of strokes services - goals for 2015: - In Europe all patients with stroke will have access to a continuum of care from organized stroke units in the acute phase to appropriate rehabilitation and secondary prevention measures.
Management of Acute Stroke - goal for 2015: - More than 85% of stroke patients will survive the first month.
- All patients with acute stroke will be transferred to hospitals with technical capabilities and expertise to administer thrombolytic treatment.
Prevention - goals for 2015: - The incidence of stroke should be reduced by at least 20% from the level of 2005.
- All countries should aim at reducing major determinants of stroke in their populations, most importantly hypertension and smoking.
- In patients who have suffered a stroke and survived the acute phase, 2-year survival should be above 80%.
Rehabilitation after stroke - goal for 2015: - Three months after the stroke onset, over 70% of the surviving patients should be independent in activities of daily living (ADL).
Evaluation of stroke outcome and quality assessment - goal for 2015: - All Member States should establish a system for routine collection of data needed to evaluate the quality of stroke management, including patient safety issues.
It was emphasised that STROKE IS EMERGENCY and that rapid recognition and reaction to stroke warning signs is essential. Incidence: - Stroke is the second highest reason for death in Europe after heart disease.
- According to data, the stroke incidence each year in Europe is 1 - 2 millions, and 300.000 die of stroke each year.
- There is a clear pattern in stroke mortality. The trends show a higher rate of stroke mortality in the Eastern European countries where the rate is increasing compared to the Western European countries where the mortality is decreasing.
- The estimation is that by the year 2020, the number of disabled people because of stroke will have increased by 30% if nothing is done.
- There is insufficient control of risk factors.
Successful care: - The Emergency medical System and emergency team s the key to successful care.
- Good training of paramedics is essential. They must have knowledge on brain attack and know the warning signs.
- Acute care and evaluation in the emergency room is essential.
- Time from onset to treatment should be less than 2 hours.
- RT-PA (Thrombolysis) should be administered within 3 hours from onset of stroke for all eligible patients for thrombolytic treatment and therefore these patients should be admitted to hospitals that are equipped to do this treatment.
- Stroke patients should be treated in dedicated stroke units as they have shown evidence of effect. ccording to the consensus document, the minimum criteria for a stroke unit include the following items:
- Dedicated beds for stroke patients.
- Dedicated multidisciplinary teams that include a stroke physician, trained nurses, physiotherapists, occupational therapists and speech therapists.
- Immediate imaging 24 hours (CT or MRI). It is realised that this criterion may not be met in all stoke units in all Member States due to economic constraints.
- Written protocols and pathways for diagnostic procedures, acute treatment, monitoring to prevent complications and secondary prevention.
- Availability of neurosurgery, vascular surgery, interventional neuroradiology, cardiology is preferable but not an absolute requirement for a stroke unit.
- Immediate start of mobilisation and early rehabilitation.
- Continuing staff education.
- Stroke is a considerable and lasting strain that affects all areas of living. There is a need for high level models of rehabilitation services with:
- Good access
- Early input
- Problem focused approach
- Multidisciplinary team
- Continuous chain of care
- Support system in the community
Prevention: Reference was made to several websites with further information on stroke management: WHO STEPWISE approach to surveillance is the recommended WHO tool: www.who.int/ned-surveillance/infobase www.who.int/nce-surveillance/steps www.who.int/chp/steps/stroke www.who.intg/chp Chronic disease report The European Region of WCPT encourages physiotherapists to participate and be proactive in the management of stroke services and in prevention of stroke. Sigrún Knútsdóttir,
First Vice Chairman
European Region of WCPT |
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