Centre for Clinical Research Excellence in Aphasia Rehabilitation, The University of Queensland, Brisbane, Queensland, Australia.
J Eval Clin Pract. 2013 Dec;19(6):994-1003. doi: 10.1111/jep.12023. Epub 2013 Mar 1.
RATIONALE, AIMS AND OBJECTIVES: Aphasia affects up to 38% of stroke survivors. Clinical guidelines can improve patient care and outcomes. Given the importance of aphasia management in stroke care, the purpose of this study was to systematically search for, retrieve and assess the quality of currently published clinical guidelines for aphasia in stroke management.
Systematic search of bibliographic resources, publications, association websites, databases, Internet and pearling revealed multidisciplinary stroke and speech pathology-specific clinical guidelines, which were evaluated using the Appraisal of Guidelines and Research and Evaluation (AGREE) II tool. Guidelines obtaining a rigour of development score above 66.67% in AGREE II evaluations underwent further ADAPTE Collaboration tool analysis.
There was significant variability in methodological rigour, reporting of guideline development processes and scope of coverage of recommendations pertaining to aphasia management provided within the guidelines. The Australian Clinical Guidelines for Stroke Management (2010) and New Zealand Clinical Guidelines for Stroke Management (2010) achieved the highest scores (74% and 81%, respectively) in AGREE II analysis and both obtained a 'yes' in all seven ADAPTE domains. The Scottish Intercollegiate Guideline Network 108 (2008) guideline achieved 73% in AGREE II and six out of seven 'yes' in ADAPTE, however, contained no aphasia-specific recommendations. The Royal College of Speech and Language Therapists (2005) guideline provided the most comprehensive aphasia coverage, however, demonstrated lower methodological rigour in AGREE II (64%) and ADAPTE evaluations (three 'yes' out of seven).
Improvement is needed in the quality of methodological rigour in development and reporting within clinical guidelines, and in aphasia-specific recommendations within stroke multidisciplinary clinical guidelines.
背景、目的和目标：失语症影响多达 38%的中风幸存者。临床指南可以改善患者的护理和结局。鉴于失语症管理在中风护理中的重要性，本研究的目的是系统地搜索、检索和评估目前发表的中风管理中失语症临床指南的质量。
系统地搜索了文献资源、出版物、协会网站、数据库、互联网和珍珠搜索，揭示了多学科中风和言语病理学特定的临床指南，使用评估指南和研究与评估 (AGREE) II 工具对这些指南进行了评估。AGREE II 评估中开发严谨度评分超过 66.67%的指南，进行了进一步的 ADAPTE 合作工具分析。
在指南中提供的失语症管理方法的严谨性、指南制定过程的报告以及建议涵盖范围方面存在显著的差异。澳大利亚中风管理临床指南 (2010 年) 和新西兰中风管理临床指南 (2010 年) 在 AGREE II 分析中获得了最高分数 (分别为 74%和 81%)，并且在 ADAPTE 的所有七个领域都获得了“是”。苏格兰校际指南网络 108 (2008 年) 指南在 AGREE II 中获得了 73%，并且在 ADAPTE 中有六个“是”，但没有专门针对失语症的建议。皇家言语治疗师学院 (2005 年) 指南提供了最全面的失语症覆盖范围，但在 AGREE II (64%)和 ADAPTE 评估 (七个中三个“是”) 中显示出较低的方法严谨性。
需要提高临床指南制定和报告中的方法严谨性质量，以及多学科中风临床指南中针对失语症的具体建议。
