924 Disability & Rehabilitation, 2013; 35(11): 924–930 © 2013 Informa UK, Ltd. ISSN 0963-8288 print/ISSN 1464-5165 online DOI: 10.3109/09638288.2012.726315 Purpose: Thrombolysis with tissue plasminogen activator (rtPA) is currently used throughout the world in acute ischaemic stroke management. In this review, we will explore the status of our current knowledge about the effects of rtPA on specific rehabilitation domains and highlight some key knowledge gaps. Methods: Narrative review of the larger clinical and postmarketing surveillance studies. Results: To date, most of the previous research into rtPA for acute ischaemic stroke has focused on safety and efficacy using general outcome measures and has ceased following patients 90 days after rtPA administration. This research has provided valuable information about the safety and efficacy of rtPA and has facilitated the introduction of rtPA into clinical practice for stroke management. However there is a paucity of knowledge about the long-term recovery patterns of patients post-rtPA, including the effect of rtPA on specific rehabilitation domains and its impact on post-acute service delivery. Furthermore, limited information is available about the effect of rtPA on post-stroke quality of life and participation in society. Conclusion: These knowledge gaps have substantial implications for the long-term management of patients by rehabilitation teams. Increasing our knowledge in these areas may assist us to predict which individuals are most likely to benefit from thrombolysis with rtPA, and enable us to provide optimal rehabilitation programs to maximise functional outcomes and quality of life post-stroke. Keywords: Thrombolysis, rtPA, stroke, allied health, outcomes, rehabilitation, review Introduction Stroke is currently a major cause of death and disability throughout the world [1,2]. Worldwide, it has been estimated that approximately 15 million individuals will experience a stroke each year, leaving approximately 5 million individuals with permanent stroke-induced impairments [3]. Strokes can be classiied into two main groups: ischaemic and haemorrhagic. Ischaemic strokes encapsulate approximately 80–85% of all strokes and are caused primarily by a blockage in a blood vessel within the brain [1,4]. hrombolysis shortly ater an ischaemic stroke may potentially reduce the neurological damage by facilitating tissue reperfusion via endogenous recanalisation mechanisms [4–6]. Some studies have revealed that thrombolysed stroke patients with extensive reperfusion have a greater chance of being functionally independent, or achieving a “good outcome” as deined by performance on one or more measures including the National Institutes of Health Stroke Scale (NIHSS) [7], modiied Rankin Scale (mRS) [8], and/or Barthel Index (BI) [9,10]. As a result, thrombolysis has changed attitudes towards stroke management worldwide, with many countries now adopting thrombolysis as part of their management program for acute stroke patients [11]. However, despite PERSPECTIVES IN REHABILITATION Identifying implications of thrombolysis for stroke rehabilitation: Knowledge gaps in current research Emma Finch 1–3 , Kathryn S. Hayward 4 , Jennifer Fleming 3,5,6 & David A. Copland 1,7 1 Division of Speech Pathology, The University of Queensland, 2 Speech Pathology Department, Princess Alexandra Hospital, 3 Centre for Functioning and Health Research, Queensland Health, 4 Division of Physiotherapy, The University of Queensland, 5 Division of Occupational Therapy, The University of Queensland, 6 Occupational Therapy Department, Princess Alexandra Hospital, and 7 Centre for Clinical Research, The University of Queensland Correspondence: Emma Finch, Division of Speech Pathology, he University of Queensland, St Lucia QLD 4072, Australia. E-mail: e.whiting@uq.edu.au • hrombolysis with tissue plasminogen activator (rtPA) is currently used throughout the world in acute ischaemic stroke management. • Previous research into rtPA has focused on largely on safety and eicacy using general outcome measures. • here is a lack of knowledge about the long-term recovery patterns and service requirements of patients post-rtPA, which has important implications for the management of these patients by rehabilitation teams. Implications for Rehabilitation (Accepted August 2012) Disabil Rehabil Downloaded from informahealthcare.com by University of Queensland on 03/22/15 For personal use only.