POSITION PAPER Stroke management: updated recommendations for treatment along the care continuum L. Wright, 1 K. M. Hill, 1 J. Bernhardt, 2,3 R. Lindley, 4 L. Ada, 5 B. V. Bajorek, 6 P. A. Barber, 20 C. Beer, 11,12 J. Golledge, 14 L. Gustafsson, 15 D. Hersh, 13 J. Kenardy, 16 L. Perry, 7,8 S. Middleton, 9,10 S. G. Brauer 17 and M. R. Nelson 18,19 ; on behalf of the National Stroke Foundation Stroke Guidelines Expert Working Group 1 Guidelines Program, National Stroke Foundation, 2 Stroke Division, Florey Neuroscience Institutes, 3 La Trobe University, Melbourne, Victoria, 4 Discipline of Medicine, 5 Discipline of Physiotherapy, The University of Sydney, 6 School of Pharmacy, The University of Technology Sydney and Royal North Shore Hospital, 7 Faculty of Nursing, Midwifery and Health, University of Technology Sydney, 8 Prince of Wales, Sydney/Sydney Eye Hospitals, South East Sydney Local Health District, 9 Nursing Research Institute, St Vincents & Mater Health Sydney and Australian Catholic University, 10 National Centre for Clinical Outcomes Research, Australian Catholic University, Sydney, New South Wales, 11 Western Australian Centre for Health and Ageing, Centre for Medical Research and School of Medicine and Pharmacology, University of Western Australia, 12 Royal Perth Hospital, 13 School of Psychology and Social Science, Edith Cowan University, Perth, Western Australia, 14 Vascular Biology Unit, School of Medicine and Dentistry, James Cook University, Townsville, 15 Division of Occupational Therapy, 16 Schools of Medicine and Psychology, and 17 Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, 18 Discipline of General Practice, University of Tasmania, 19 Menzies Research Institute Tasmania, Hobart, Tasmania, Australia, and 20 Department of Medicine, University of Auckland, Auckland, New Zealand Key words stroke, cerebrovascular disease, clinical guideline, acute management, rehabilitation. Correspondence Leah Wright, Guidelines Program, National Stroke Foundation, Level 7, 461 Bourke Street, Melbourne, Vic. 3000, Australia. Email: lwright@strokefoundation.com.au Received 26 June 2011; accepted 11 February 2012. doi:10.1111/j.1445-5994.2012.02774.x Abstract The Australian Clinical Guidelines for Stroke Management 2010 represents an update of the Clinical Guidelines for Stroke Rehabilitation and Recovery (2005) and the Clinical Guidelines for Acute Stroke Management (2007). For the first time, they cover the whole spectrum of stroke, from public awareness and prehospital response to stroke unit and stroke management strategies, acute treatment, secondary prevention, rehabilita- tion and community care. The guidelines also include recommendations on transient ischaemic attack. The most significant changes to previous guideline recommendations include the extension of the stroke thrombolysis window from 3 to 4.5 h and the change from positive to negative recommendations for the use of thigh-length antithrombotic stockings for deep venous thrombosis prevention and the routine use of prolonged positioning for contracture management. There are approximately 60 000 first ever or recurrent strokes in Australia every year. Nine in 10 people who have a stroke are admitted to hospital. 1 There is now good evidence that coordinated, multidisciplinary care for stroke reduces death and disability. 2 To promote consis- tent, evidence-based care, the Clinical Guidelines for Stroke Rehabilitation and Recovery (2005) and the Clini- cal Guidelines for Acute Stroke Management (2007) were developed. Recognising the need for acute and rehabilita- tive care for stroke to be synchronous and the rapid accumulation of new evidence, the National Stroke Foun- dation (NSF) has overseen the review and consolidation of the two guidelines. This position statement provides a summary of the updated national clinical guidelines for adults with stroke or transient ischaemic attack (TIA). Development of the Clinical Guidelines for Stroke Management The Clinical Guidelines for Stroke Management 2010 3 were developed by the NSF according to processes prescribed by the National Health and Medical Research Council (NHMRC) 4 under the direction of an interdisciplinary Expert Working Group (EWG). Grading of each recom- mendation is included using the NHMRC grading system (Table 1). The full guidelines and related resources can be Funding: The Clinical Guidelines for Stroke Management 2010 were funded by the Department of Health and Ageing, Austra- lian Government, Canberra. Conflict of interest: None. Internal Medicine Journal 42 (2012) © 2012 National Stroke Foundation Internal Medicine Journal © 2012 Royal Australasian College of Physicians 562