University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, UK.
Implement Sci. 2013 Oct 1;8:115. doi: 10.1186/1748-5908-8-115.
Multiple guidelines are often available to inform practice in complex interventions. Guidance implementation may be facilitated if it is tailored to particular clinical issues and contexts. It should also aim to specify all elements of interventions that may mediate and modify effectiveness, including both their content and delivery. We conducted a focused synthesis of recommendations from stroke practice guidelines to produce a structured and comprehensive account to facilitate the development of community-based exercise programmes after stroke.
Published stroke clinical practice guidelines were searched for recommendations relevant to the content and delivery of community-based exercise interventions after stroke. These were synthesised using a framework based on target intervention outcomes, personal and programme proximal objectives, and recommended strategies.
Nineteen guidelines were included in the synthesis (STRIDES; STroke Rehabilitation Intervention-Development Evidence Synthesis). Eight target outcomes, 14 proximal objectives, and 94 recommended strategies were identified. The synthesis was structured to present best practice recommendations in a format that could be used by intervention programme developers. It addresses both programme content and context, including personal factors, service standards and delivery issues. Some recommendations relating to content, and many relating to delivery and other contextual issues, were based on low level evidence or expert opinion. Where opinion varied, the synthesis indicates the range of best practice options suggested in guidelines.
The synthesis may assist implementation of best practice by providing a structured intervention description that focuses on a particular clinical application, addresses practical issues involved in programme development and provision, and illustrates the range of best-practice options available to users where robust evidence is lacking. The synthesis approach could be applied to other areas of stroke rehabilitation or to other complex interventions.
在复杂干预措施中，通常有多种指南可供参考。如果指导实施针对特定的临床问题和背景进行定制，并且旨在明确干预措施中可能影响和改变效果的所有要素，包括内容和实施方式，那么指导实施可能会得到促进。我们对中风实践指南中的建议进行了重点综合，以提供一种结构化和全面的说明，以促进中风后社区锻炼计划的制定。
搜索了与中风后社区锻炼干预内容和实施相关的建议发表的中风临床实践指南。这些建议使用基于目标干预结果、个人和计划近端目标以及推荐策略的框架进行综合。
19 项指南纳入了综合分析（STRIDES；STroke Rehabilitation Intervention-Development Evidence Synthesis）。确定了 8 个目标结果、14 个近端目标和 94 个推荐策略。综合分析的结构旨在以可由干预计划开发者使用的格式呈现最佳实践建议。它既涉及到方案内容又涉及到方案背景，包括个人因素、服务标准和实施问题。一些与内容相关的建议，以及许多与实施和其他背景问题相关的建议，都是基于低水平的证据或专家意见。在意见存在分歧的情况下，综合分析表明了指南中建议的最佳实践选项的范围。
该综合分析可以通过提供一个专注于特定临床应用的结构化干预描述来协助实施最佳实践，解决方案开发和实施中涉及的实际问题，并说明在缺乏确凿证据的情况下，用户可选择的最佳实践选项的范围。这种综合分析方法可以应用于中风康复的其他领域或其他复杂干预措施。
