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Quality of stroke rehabilitation clinical practice guidelines.
J Eval Clin Pract 2007; 13(4):657-64JE

Abstract

BACKGROUND AND PURPOSE

Clinical practice guidelines (CPGs) are systematically developed statements that assist practitioners to provide appropriate evidence-based care. The purpose of this study was to evaluate the quality of currently published CPGs for stroke care and to examine the reliability and validity of the appraisal of guidelines, research and evaluation (AGREE) instrument.

METHODS

Multiple databases and Internet resources were searched for stroke care CPGs. Guidelines included were published in English or French from 1998 to 2004 and developed by a group process. Four appraisers evaluated each CPG using the AGREE instrument. The AGREE consists of 23 items, ranked on a 4-point Likert scale, that is organized into six domains. A standardized score is calculated separately for each domain and ranges from 0 to 100.

RESULTS

Eight guidelines were identified. The AGREE quality scores were high for the 'scope and purpose' domain (mean +/- SE = 71.2 +/- 5.48, intra-class correlation (ICC) = 0.66), and 'clarity and presentation' (mean +/- SE = 70.6 +/- 4.43, ICC = 0.66). There was wide variation in ratings of 'rigour of development' (mean +/- SE = 60.7 +/- 7.1, ICC = 0.75) and 'stakeholder involvement' (mean +/- SE = 52.6 +/- 7.14, ICC = 0.89). The 'editorial independence' (mean +/- SE = 38.1 +/- 8.72, ICC = 0.88) and 'applicability' (mean +/- SE = 35.1 +/- 4.93, ICC = 0.75) had the lowest scores.

CONCLUSIONS

There is considerable variability in quality of stroke care guidelines but stroke guidelines score higher on the AGREE rigour of development domain than CPGs from other medical fields. The Scottish Intercollegiate Guideline Network, Veterans Affairs/Department of Defence, Royal College of Physicians, and the New Zealand Guidelines Group consistently scored the highest across the domains. Stroke rehabilitation clinicians should consider these results in selecting a guideline. CPG development groups can improve their AGREE scores by considering the cost of implementing their CPGs, pilot testing their CPGs, recording conflict of interest of development panel members and providing tools supporting application of their CPGs.

Authors+Show Affiliations

Toronto Rehabilitation Institute, Toronto, ON, Canada. amanda.hurdowar@sickkids.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17683311

Citation

Hurdowar, Amanda, et al. "Quality of Stroke Rehabilitation Clinical Practice Guidelines." Journal of Evaluation in Clinical Practice, vol. 13, no. 4, 2007, pp. 657-64.
Hurdowar A, Graham ID, Bayley M, et al. Quality of stroke rehabilitation clinical practice guidelines. J Eval Clin Pract. 2007;13(4):657-64.
Hurdowar, A., Graham, I. D., Bayley, M., Harrison, M., Wood-Dauphinee, S., & Bhogal, S. (2007). Quality of stroke rehabilitation clinical practice guidelines. Journal of Evaluation in Clinical Practice, 13(4), pp. 657-64.
Hurdowar A, et al. Quality of Stroke Rehabilitation Clinical Practice Guidelines. J Eval Clin Pract. 2007;13(4):657-64. PubMed PMID: 17683311.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quality of stroke rehabilitation clinical practice guidelines. AU - Hurdowar,Amanda, AU - Graham,Ian D, AU - Bayley,Mark, AU - Harrison,Margaret, AU - Wood-Dauphinee,Sharon, AU - Bhogal,Sanjit, PY - 2007/8/9/pubmed PY - 2007/10/18/medline PY - 2007/8/9/entrez SP - 657 EP - 64 JF - Journal of evaluation in clinical practice JO - J Eval Clin Pract VL - 13 IS - 4 N2 - BACKGROUND AND PURPOSE: Clinical practice guidelines (CPGs) are systematically developed statements that assist practitioners to provide appropriate evidence-based care. The purpose of this study was to evaluate the quality of currently published CPGs for stroke care and to examine the reliability and validity of the appraisal of guidelines, research and evaluation (AGREE) instrument. METHODS: Multiple databases and Internet resources were searched for stroke care CPGs. Guidelines included were published in English or French from 1998 to 2004 and developed by a group process. Four appraisers evaluated each CPG using the AGREE instrument. The AGREE consists of 23 items, ranked on a 4-point Likert scale, that is organized into six domains. A standardized score is calculated separately for each domain and ranges from 0 to 100. RESULTS: Eight guidelines were identified. The AGREE quality scores were high for the 'scope and purpose' domain (mean +/- SE = 71.2 +/- 5.48, intra-class correlation (ICC) = 0.66), and 'clarity and presentation' (mean +/- SE = 70.6 +/- 4.43, ICC = 0.66). There was wide variation in ratings of 'rigour of development' (mean +/- SE = 60.7 +/- 7.1, ICC = 0.75) and 'stakeholder involvement' (mean +/- SE = 52.6 +/- 7.14, ICC = 0.89). The 'editorial independence' (mean +/- SE = 38.1 +/- 8.72, ICC = 0.88) and 'applicability' (mean +/- SE = 35.1 +/- 4.93, ICC = 0.75) had the lowest scores. CONCLUSIONS: There is considerable variability in quality of stroke care guidelines but stroke guidelines score higher on the AGREE rigour of development domain than CPGs from other medical fields. The Scottish Intercollegiate Guideline Network, Veterans Affairs/Department of Defence, Royal College of Physicians, and the New Zealand Guidelines Group consistently scored the highest across the domains. Stroke rehabilitation clinicians should consider these results in selecting a guideline. CPG development groups can improve their AGREE scores by considering the cost of implementing their CPGs, pilot testing their CPGs, recording conflict of interest of development panel members and providing tools supporting application of their CPGs. SN - 1356-1294 UR - https://www.unboundmedicine.com/medline/citation/17683311/Quality_of_stroke_rehabilitation_clinical_practice_guidelines_ L2 - https://doi.org/10.1111/j.1365-2753.2007.00708.x DB - PRIME DP - Unbound Medicine ER -