Not enough stroke victims are being referred to rehabilitation, with less than 30 per cent of the 50,000 Canadians who suffer a stroke annually receiving treatment, says an international rehabilitation expert.
Instead, many are sent by their physicians for shorter and more costly treatments, such as the administration of new blood clot-dissolving drugs such as Tissue Plasminogen Activator (t-PA), says Dr. Robert Teasell, chief of physical medicine and rehabilitation at Parkwood Hospital, St. Joseph's Health Care, in London, Ont.
Teasell is currently preparing a report about the decline in stroke rehabilitation for the Canadian Medical Association Journal.
"Rehab is not sexy. It's been pushed to the back," he told CBC News. "We've lost our way."
Teasell said numerous international studies have found that stroke rehabilitation is critical in restoring a person's ability to function.
"One of the things that's becoming more popular in other countries is providing much more intensive therapy, with the idea of improving patients' neurological recovery and the chances that they'll go home." Physical and cognitive therapy includes daily treatment under the care of physiotherapists, occupational therapists, speech and language pathologists and dietitians.
Instead, he said, doctors are increasingly turning to drugs like t-PA, which is now frequently administered to stroke victims to dissolve blood clots. To be effective, it must be given within three hours of the first stroke. It's also expensive, at a cost of approximately $2,000 per treatment.
What is currently happening, said Teasell, is that the provinces are spending more of their health budgets on costly medications like t-PA, while not investing enough in post-stroke rehabilitation, which actually reduces the cost to the province.
He predicts the situation will only get worse with Canada's rapidly aging population. "We've invested in prevention, we've invested in acute care with t-PA, but our investment in rehab has been very little. So we are not prepared for this influx of stroke patients coming down the road."
He said that without rehabilitation, many stroke victims may end up in nursing homes and institutional care, which will further increase health-care costs. "If they had rehabilitation, they could go home," he said.
Dr. Sandra Black, a neurologist with Sunnybrook and Women's College Health Sciences Centre in Toronto, agreed there's a need for more rehabilitation, but she says it shouldn't be at the expense of t-PA.
"It's very compelling to prevent a stroke and I don't think that we should apologize for the fact that there's been some investment."
Strokes cost the Canadian health-care system more than $2.4 billion a year, according to the Canadian Heart and Stroke Foundation.
Corrections and Clarifications
- Dr. Robert Teasell is chief of physical medicine and rehabilitation at Parkwood Hospital, St. Joseph's Health Care, in London, Ont. He does not hold that role at London Health Sciences Centre, as was originally reported. July 25, 2007|4:35 p.m.
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