From the Guidelines
The multicontext approach in stroke care is supported by evidence, as it allows for tailored and effective management of stroke in various settings, including rural and low-resource areas, ultimately reducing morbidity and mortality. This approach is crucial in stroke care, as it considers the specific needs and limitations of different contexts, such as rural areas in developing countries, where ideal recommendations may not be feasible due to cost-effectiveness and practicality concerns 1. The importance of a multicontext approach is highlighted by the fact that more than 60% of stroke mortality in low-income countries is due to a small number of modifiable risk factors, and with correct management, stroke risk can be significantly reduced 1. Key aspects of this approach include:
- Coordinated stroke care in stroke units, which reduces death and dependency by 56 per 1000 people treated 1
- Implementation of practical measures for management of all steps in the detection and management of stroke, appropriate for low-resource rural areas 1
- Emphasis on management of hypertension, the most consistent predictor of stroke, causing about 54% of stroke mortality in the developing world 1
- Involvement of family participation in stroke care, as home rehabilitation has been shown to be as effective as inpatient rehabilitation and can be used in rural settings 1
- Consideration of cultural factors that may play a role in obstructing prompt medical care, such as seeking help from traditional healers before western medicine 1. Overall, the multicontext approach in stroke care prioritizes effective, evidence-based, and sustainable management, tailored to the specific needs of different contexts, ultimately improving outcomes and reducing morbidity and mortality.
From the Research
Evidence for Multicontext Approach in Stroke
- The multicontext approach in stroke management involves a comprehensive and individualized treatment plan, taking into account the patient's specific needs and circumstances 2.
- This approach is supported by recent advances in stroke care, including the use of multimodal CT and MRI, and the development of new treatments such as mechanical thrombectomy and thrombolytics 2, 3.
- The management of acute ischemic stroke requires a multidisciplinary approach, involving early recognition, emergency interventional treatment, and treatment in dedicated stroke centers 3, 4.
- The use of dual antiplatelet therapy (DAPT) has been shown to be effective in preventing recurrent stroke, particularly in patients with high-risk transient ischemic attack or mild-moderate ischemic stroke 5.
- However, the management strategy for patients with aspirin treatment failure has not been fully established, and further research is needed to identify the best management strategies for this complex clinical scenario 6.
Key Components of Multicontext Approach
- Early recognition and diagnosis of stroke
- Individualized treatment plan, taking into account the patient's specific needs and circumstances
- Use of multimodal CT and MRI to guide treatment decisions
- Mechanical thrombectomy and thrombolytics as treatment options
- Dual antiplatelet therapy (DAPT) for preventing recurrent stroke
- Multidisciplinary approach, involving emergency interventional treatment and treatment in dedicated stroke centers
Benefits of Multicontext Approach
- Reduced stroke-related morbidity and mortality
- Improved functional outcomes and increased likelihood of functional independence
- Personalized treatment plan, tailored to the individual patient's needs
- Increased use of evidence-based treatments, such as mechanical thrombectomy and thrombolytics
- Reduced risk of recurrent stroke, particularly in patients with high-risk transient ischemic attack or mild-moderate ischemic stroke 5