创伤性脑损伤后认知康复指南的质量
Quality of guidelines for cognitive rehabilitation following traumatic brain injury.
作者信息
Bragge Peter, Pattuwage Loyal, Marshall Shawn, Pitt Veronica, Piccenna Loretta, Stergiou-Kita Mary, Tate Robyn L, Teasell Robert, Wiseman-Hakes Catherine, Kua Ailene, Ponsford Jennie, Velikonja Diana, Bayley Mark
机构信息
National Trauma Research Institute, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia (Drs Bragge, Pitt, and Piccenna and Mr Pattuwage); The Ottawa Hospital Rehabilitation Center, University of Ottawa, Ottawa, Ontario, Canada (Dr Marshall); University of Toronto and Toronto Rehabilitation Institute, Toronto, Ontario, Canada (Dr Stergiou-Kita); UHN-Toronto Rehabilitation Institute and Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (Dr Bayley); Rehabilitation Studies Unit, Sydney Medical School - Northern, The University of Sydney, New South Wales, Australia (Professor Tate); Lawson Research Institute and Western University, London, Ontario, Canada (Dr Teasell); Bloorview Research Institute, Holland, Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada (Dr Wiseman-Hakes); Toronto Rehabilitation Institute, Toronto, Ontario, Canada (Ms Kua); Monash-Epworth Rehabilitation Research Centre, Epworth Hospital and School of Psychological Sciences, Monash University, Victoria, Australia (Professor Ponsford); and Acquired Brain Injury Program, Hamilton Health Sciences, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Velikonja).
出版信息
J Head Trauma Rehabil. 2014 Jul-Aug;29(4):277-89. doi: 10.1097/HTR.0000000000000066.
INTRODUCTION
Cognitive rehabilitation following traumatic brain injury can aid in optimizing function, independence, and quality of life by addressing impairments in attention, executive function, cognitive communication, and memory. This study aimed to identify and evaluate the methodological quality of clinical practice guidelines for cognitive rehabilitation following traumatic brain injury.
METHODS
Systematic searching of databases and Web sites was undertaken between January and March 2012 to identify freely available, English language clinical practice guidelines from 2002 onward. Eligible guidelines were evaluated using the validated Appraisal of Guidelines for Research and Evaluation II instrument.
RESULTS
The 11 guidelines that met inclusion criteria were independently rated by 4 raters. Results of quality appraisal indicated that guidelines generally employed systematic search and appraisal methods and produced unambiguous, clearly identifiable recommendations. Conversely, only 1 guideline incorporated implementation and audit information, and there was poor reporting of processes for formulating, reviewing, and ensuring currency of recommendations and incorporating patient preferences. Intraclass correlation coefficients for agreement between raters showed high agreement (intraclass correlation coefficient > 0.80) for all guidelines except for 1 (moderate agreement; intraclass correlation coefficient = 0.76).
CONCLUSION
Future guidelines should address identified limitations by providing implementation information and audit criteria, along with better reporting of guideline development processes and stakeholder engagement.
引言
创伤性脑损伤后的认知康复可通过解决注意力、执行功能、认知交流和记忆方面的损伤，帮助优化功能、提高独立性和改善生活质量。本研究旨在识别和评估创伤性脑损伤后认知康复临床实践指南的方法学质量。
方法
于2012年1月至3月对数据库和网站进行系统检索，以识别2002年起可免费获取的英文临床实践指南。使用经过验证的《研究与评价指南评估II》工具对符合条件的指南进行评估。
结果
4名评估者对符合纳入标准的11项指南进行了独立评分。质量评估结果表明，指南通常采用系统的检索和评估方法，并给出了明确、可识别的建议。相反，只有1项指南纳入了实施和审核信息，对于建议的制定、审查、确保时效性以及纳入患者偏好的过程，报告情况较差。评估者之间一致性的组内相关系数显示，除1项指南外（中等一致性；组内相关系数 = 0.76），所有指南的一致性都很高（组内相关系数 > 0.80）。
结论
未来的指南应通过提供实施信息和审核标准，以及更好地报告指南制定过程和利益相关者参与情况，来解决已发现的局限性。
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