Guidelines Canadian Stroke Best Practice Recommendations: Managing transitions of care following Stroke, Guidelines Update 2016 Jill I Cameron 1,2,3 , Colleen O’Connell 4,5 , Norine Foley 6,7 , Katherine Salter 7 , Rhonda Booth 8 , Rosemary Boyle 9 , Donna Cheung 10 , Nancy Cooper 11,12 , Helene Corriveau 13 , Dar Dowlatshahi 14,15 , Annie Dulude 16 , Patti Flaherty 17,18 , Ev Glasser 19 , Gord Gubitz 20,21 , Debbie Hebert 3 , Jacquie Holzmann 22 , Patrick Hurteau 23 , Elise Lamy 24 , Suzanne LeClaire 25 , Taylor McMillan 26 , Judy Murray 27 , David Scarfone 28 , Eric E Smith 29,30 , Vivian Shum 31 , Kim Taylor 32 , Trudy Taylor 33 , Catherine Yanchula 34 , Robert Teasell 35 and Patrice Lindsay 12,19 ; on behalf of the Heart and Stroke Foundation Canadian Stroke Best Practice Committees Abstract Every year, approximately 62,000 people with stroke and transient ischemic attack are treated in Canadian hospitals. For patients, families and caregivers, this can be a difficult time of adjustment. The 2016 update of the Canadian Managing Transitions of Care following Stroke guideline is a comprehensive summary of current evidence-based and consensus-based recommendations appropriate for use by clinicians who provide care to patients following stroke across a broad range of settings. The focus of these recommendations is on support, education and skills training for patients, families and caregivers; effective discharge planning; interprofessional communication; adaptation in resuming activities of daily living; and transition to long-term care for patients who are unable to return to or remain at home. Unlike other modules 1 Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada 2 Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada 3 Toronto Rehabilitation Institute, Toronto, Canada 4 Faculty of Medicine, Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Canada 5 Stan Cassidy Centre for Rehabilitation, Saint John, Canada 6 Faculty of Nutrition Sciences, Western University, London, Canada 7 workHORSE Consulting Inc., London, Canada 8 Nova Scotia Rehabilitation Centre, Halifax, Canada 9 Department of Health, Chronic Disease Prevention and Management Unit, New Brunswick, Canada 10 South East Toronto Stroke Network, Toronto, Canada 11 Ontario Long Term Care Association, Toronto, Canada 12 Institute Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada 13 Universite ´ de Sherbrooke, E ´ cole de re ´adaptation, Que ´bec, Canada 14 The Ottawa Hospital Stroke Program, Ottawa, Canada 15 Faculty of Medicine, University of Ottawa, Ontario, Canada 16 Stroke Survivor, Quebec, Canada 17 CONNECT Communities, British Columbia, Canada 18 British Columbia Brain Injury Association, Vancouver, Canada 19 Heart and Stroke Foundation, Ottawa, Canada 20 Faculty of Medicine, Dalhousie University, Nova Scotia, Canada 21 Queen Elizabeth II Health Sciences Centre, Capital District Health Authority, Halifax, Canada 22 Integrated Primary Health Services, Sunrise Health Region, Saskatchewan, Canada 23 Stroke Rehabilitation Program, Bruye `re Continuing Care, Ottawa, Canada 24 Villa Medica Ho ˆpital de re ´adaptation, Quebec, Canada 25 Saskatoon Health Region, Saskatoon, Canada 26 Winnipeg Regional Health Authority Home Care Program, Winnipeg, Canada 27 Mackenzie Health District Stroke Centre, Richmond Hill, Canada 28 Family Physician Practice, Windsor, Canada 29 Calgary Stroke Program, Calgary, Canada 30 Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Canada 31 CARECORP Seniors Services, Vancouver, Canada 32 Parkridge Centre, Saskatoon Health Region, Saskatoon, Canada 33 Carewest Dr. Vernon Fanning Centre, Calgary, Canada 34 Schulich School of Medicine & Dentistry, Western University – Windsor Program, Windsor, Canada 35 Department of Physical Medicine and Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, Canada Corresponding author: Patrice Lindsay, Heart and Stroke Foundation, 222 Queen Street, Suite 1402, Ottawa, Ontario K1P 5V9, Canada. Email: plindsay@hsf.ca International Journal of Stroke, 11(7) International Journal of Stroke 2016, Vol. 11(7) 807–822 ! 2016 World Stroke Organization Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1747493016660102 wso.sagepub.com