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About 4.5 million people worldwide die from stroke each year, and 9 million are estimated to be living with its consequences. One in every three deaths in the UK results from stroke, and it is the single greatest cause of disability in the adult population. Given that the incidence of stroke is estimated to rise by as much as 30% over the next 20 years,¹ it represents a major and ongoing challenge for society. For the people who survive the initial insult, there can be residual difficulties with self-care and mobility, communication, cognition, or emotional wellbeing. Such limitations can bring about major changes in “life”, impacting on roles and relationships within the family, social circle, and work. Stroke can clearly be a devastating condition for the individual and his or her family, but dedicated stroke services have been shown to reduce the impact both in terms of mortality and morbidity.

Quite why stroke units work is yet to be clearly established. They rely on a complex combination of skilled staff in a range of professions, acute treatment with thrombolytic agents, early mobilisation, patient motivation, and a host of other factors. Discerning and monitoring the most active ingredients is therefore a difficult task. However, a number of aspects of management²³ …