Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD.
Federal University of Rio Grande do Norte-UFRN-FACISA, Santa Cruz, Brazil.
Arch Phys Med Rehabil. 2021 Sep;102(9):1764-1774. doi: 10.1016/j.apmr.2020.11.015. Epub 2021 Jan 13.
The World Health Organization's (WHO) Rehabilitation 2030 initiative is working to develop a set of evidence-based interventions selected from clinical practice guidelines for Universal Health Coverage. As an initial step, the WHO Rehabilitation Programme and Cochrane Rehabilitation convened global content experts to conduct systematic reviews of clinical practice guidelines for 20 chronic health conditions, including cerebral palsy.
Six scientific databases (Pubmed, EMBASE, Scopus, Web of Science, PEDro, CINAHL), Google Scholar, guideline databases, and professional society websites were searched.
A search strategy was implemented to identify clinical practice guidelines for cerebral palsy across the lifespan published within 10 years in English. Standardized spreadsheets were provided for process documentation, data entry, and tabulation of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Each step was completed by 2 or more group members, with disagreements resolved by discussion. Initially, 13 guidelines were identified. Five did not meet the AGREE II established threshold or criteria for inclusion. Further review by the WHO eliminated 3 more, resulting in 5 remaining guidelines.
All 339 recommendations from the 5 final guidelines, with type (assessment, intervention, or service), strength, and quality of evidence, were extracted, and an International Classification of Functioning, Disability and Health Functioning (ICF) category was assigned to each.
Most guidelines addressed mobility functions, with comorbid conditions and lifespan considerations also included. However, most were at the level of body functions. No guideline focused specifically on physical or occupational therapies to improve activity and participation, despite their prevalence in rehabilitation.
Despite the great need for high quality guidelines, this review demonstrated the limited number and range of interventions and lack of explicit use of the ICF during development of guidelines identified here. A lack of guidelines, however, does not necessarily indicate a lack of evidence. Further evidence review and development based on identified gaps and stakeholder priorities are needed.
世界卫生组织（WHO）的康复 2030 倡议正在努力从临床实践指南中开发一套针对全民健康覆盖的基于证据的干预措施。作为最初的一步，世卫组织康复方案和 Cochrane 康复召集了全球内容专家，对包括脑瘫在内的 20 种慢性健康状况的临床实践指南进行系统评价。
六个科学数据库（Pubmed、EMBASE、Scopus、Web of Science、PEDro、CINAHL）、Google Scholar、指南数据库和专业协会网站进行了搜索。
实施了一项搜索策略，以确定在过去 10 年内以英文出版的针对全生命周期脑瘫的临床实践指南。为流程文件记录、数据输入和评估研究和评估指南（AGREE II）工具的制表提供了标准化的电子表格。每个步骤都由 2 个或更多小组成员完成，分歧通过讨论解决。最初确定了 13 条指南。其中 5 条不符合 AGREE II 确定的纳入标准。世卫组织进一步审查又排除了 3 条，最终剩下 5 条指南。
从最终的 5 条指南中提取了 339 条建议，包括类型（评估、干预或服务）、强度和证据质量，并为每条建议分配了一个国际功能、残疾和健康分类（ICF）类别。
大多数指南都涉及运动功能，同时也考虑了合并症和生命周期因素。然而，大多数都处于身体功能的水平。没有指南专门针对物理或职业疗法来改善活动和参与，尽管它们在康复中很普遍。
尽管非常需要高质量的指南，但这项审查表明，这里确定的指南数量和范围有限，干预措施有限，在制定指南时缺乏明确使用 ICF。缺乏指南并不一定意味着缺乏证据。需要根据确定的差距和利益相关者的优先事项进一步进行证据审查和开发。
