Neurology Department, Hospital Universitario Fundación Santa Fe de Bogotá, Cra. 7 #117 -15, Bogotá, Colombia.
Neurology Department, Hospital Universitario Fundación Santa Fe de Bogotá, Cra. 7 #117 -15, Bogotá, Colombia; Universidad de los Andes, Cra. 7 #116-5, Bogotá, Colombia; Universidad El Bosque, Ak. 9 #131a-2, Bogotá, Colombia.
J Clin Epidemiol. 2024 Jun;170:111334. doi: 10.1016/j.jclinepi.2024.111334. Epub 2024 Mar 27.
Successful implementation of stroke rehabilitation guidelines demands high-quality practice standards tailored to targeted sociodemographic contexts. The primary objective is to determine the quality differences in post-stroke rehabilitation practice guidelines (PGs), when comparing high-income countries (HIC) and low or middle-income countries (LMIC).
We conducted a scoping review of PGs in English or Spanish, published between 2012 and 2021, and providing recommendations on post-stroke rehabilitation. We used Search engines, databases, guideline libraries, gray literature, and references from previous reviews on post-stroke rehabilitation as sources of evidence. Quality assessment of PGs was performed using 6P's, ELSE, IOM, and AGREE II instruments. We evaluated each item using a scale between 0 to 3, based on the confidence of adherence to the standard. For AGREE II, we followed the instruction manual for scoring. At least two reviewers were independently involved in every step of the process. A cloud-based spreadsheet was used to chart data. We compared the results of PGs originating from HIC with those from LMIC.
The inclusion criteria were met by 35 documents, which were subjected to evaluation. The study included 21 documents from HIC and 14 from middle-income countries (MIC). No manuscripts from low-income countries were available for inclusion in the study. The quality of PGs from MIC was found to be lower, in terms of methodological rigor and adherence to international recommendations for guidelines development. PGs from both groups of countries failed to include all target audiences and stakeholders (according to the 6P's criteria) and integration of ethical, legal, social, and economic considerations.
There are gaps in the quality and availability of stroke rehabilitation guidelines worldwide, especially in LMIC. Designing and providing financial support for the implementation of high-quality guidelines will contribute to more effective implementation strategies in stroke rehabilitation programs and lead to improved patient outcomes.
成功实施中风康复指南需要针对目标社会人口背景制定高质量的实践标准。主要目标是比较高收入国家（HIC）和低收入或中等收入国家（LMIC）中风后康复实践指南（PGs）的质量差异。
我们对 2012 年至 2021 年间以英语或西班牙语发表的关于中风后康复的 PGs 进行了范围综述，并提供了关于中风后康复的建议。我们使用搜索引擎、数据库、指南库、灰色文献以及之前关于中风后康复的综述中的参考文献作为证据来源。使用 6P's、ELSE、IOM 和 AGREE II 工具对 PGs 的质量进行评估。我们根据对标准的遵守程度，对每个项目使用 0 到 3 的量表进行评估。对于 AGREE II，我们遵循了评分说明手册。至少有两名评审员独立参与了整个过程。我们使用基于云的电子表格来记录数据。我们比较了来自 HIC 的 PGs 与来自 LMIC 的 PGs 的结果。
符合纳入标准的有 35 份文件，这些文件都经过了评估。该研究包括来自 HIC 的 21 份文件和来自中收入国家（MIC）的 14 份文件。没有来自低收入国家的手稿可纳入研究。从中收入国家获得的 PGs 在方法严谨性和遵守国际指南制定建议方面被发现质量较低。来自这两个国家的 PGs 都未能包括所有目标受众和利益相关者（根据 6P's 标准）以及纳入伦理、法律、社会和经济方面的考虑。
全世界的中风康复指南在质量和可用性方面都存在差距，特别是在 LMIC。设计和提供高质量指南的实施资金将有助于中风康复计划中更有效的实施策略，并导致患者结局的改善。
