Top Things to Know: Clinical Performance Measures for Stroke Rehabilitation

Published: August 05, 2021

  1. Stroke rehabilitation begins during acute hospital care and continues throughout the lifespan for many individuals who have sustained a stroke.
  2. There is evidence of variability in stroke rehabilitation in the US and in compliance with stroke rehabilitation guidelines, despite evidence of improved outcomes with guideline adherence.
  3. The purpose of these performance measures is to promote guideline-recommended care for persons with stroke (PwS) in the US. While the stroke rehabilitation guidelines and performance measures were developed for use in the US, many of these measures are likely to be applicable in other countries and health care systems.
  4. Thirteen performance measures are reported in the document which contains inclusion and exclusion criteria to allow calculation of rates of compliance in a variety of settings ranging from acute hospital care, through post-acute care, and in the home and outpatient setting.
  5. These performance measures were selected from the set of the highest-level (Class I) recommendations from the AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery that were judged by the Writing Group as particularly clinically salient, and where variation in practice may negatively influence patient outcomes.
  6. The performance measures focus mainly on the process of care in stroke rehabilitation and address aspects of prevention, assessment, treatment, education, choice of treatment setting and treatment standards.
  7. These performance measures cover various aspects of stroke rehabilitation in the acute, post-acute inpatient and home settings. They cover aspects of rehabilitation assessment and treatment, rehabilitation program attributes, prevention of complications, patient and family education, and decisions for selecting stroke rehabilitation setting after acute hospital discharge.
  8. While these performance measures are reported as a set of thirteen measures, they are suitable for use individually or as a subset by entities focusing on aspects of post-stroke rehabilitation care.
  9. Incorporation of these performance measures into the evaluation of stroke rehabilitation quality of care can provide a mechanism to encourage compliance with these key guideline recommendations. Use of these measures also can help to identify institutions that have achieved unusually high performance, and those with substandard performance, to facilitate broad improvements in care through adoption of best practices nationally.
  10. These measures are aimed at quality improvement and, ultimately, they may be adopted by different accreditation agencies and evaluation organizations to assess the quality and competency of stroke rehabilitation programs and systems of care for PwS.


Stein J, Katz DI, Black Schaffer RM, Cramer SC, Deutsch AF, Harvey RL, Lang CE, Ottenbacher KJ, Prvu-Bettger J, Roth EJ, Tirschwell DL, Wittenberg GF, Wolf SL, Nedungadi TP; on behalf of the American Heart Association/American Stroke Association. Clinical performance measures for stroke rehabilitation: performance measures from the American Heart Association/American Stroke Association [published online ahead of print August 5, 2021]. Stroke. doi: 10.1161/STR.0000000000000388