Gandhi Dorcas B C, Kamalakannan Sureshkumar, Urimubenshi Gerard, Sebastian Ivy A, Montanaro Vinicius V A, Chawla Nistara S, D'souza Jennifer V, Ngeh Etienne, Mahmood Amreen, Demers Marika, Hombali Aditi, Solomon John M
Physiotherapy, Manipal Academy of Higher Education, Christian Medical College and Hospital Ludhiana, Ludhiana, India.
Department of Social Work, Education, and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK.
Cerebrovasc Dis. 2024 Aug 2:1-12. doi: 10.1159/000539999.
Efforts toward reducing stroke burden have been an immense challenge. One important reasons could be the scope and quality of clinical practice guidelines (CPGs) developed for stroke rehabilitation in low- and middle-income countries (LMICs), restricting its translation to clinical practice. This systematic review aimed to assess the availability, scope and quality of CPGs for stroke rehabilitation in LMICs.
Following PRISMA guidelines, CPGs for stroke rehabilitation in LMICs were searched across four major electronic databases (Medline, Embase, CINAHL, and PEDro). Additional studies were identified from grey literature and a hand search of key bibliographies and search engines. The availability and content of the CPGs were narratively summarized and quality of de novo CPGs was analyzed using "Appraisal of Guidelines REsearch and Evaluation" (AGREE) tools: version II & Recommendations Excellence (REX) version. Features of contextualizations/adaptations of non-de novo CPGs were narratively summarized.
Twelve CPGs from 10 countries were included. CPGs from Pakistan, Sri Lanka, India, and China were developed de novo. CPGs from Kenya, Philippines, South Africa, Cameroon, Mongolia, and Ukraine were contextualized/adapted based on existing guidelines from high-income countries. Most contextualized CPGs had limited stakeholder involvement, local health systems/patient pathway analyses. All ten countries included recommendations for physiotherapy, seven for communication, swallowing, and five for occupational therapy services poststroke. Quality assessment using AGREE-REX and AGREE-II for de novo guidelines was poor, especially scoring low in development and applicability.
Contextualized CPGs for stroke rehabilitation in LMICs were scarcely available and not meeting required quality. There is a need for development of context-specific, culturally relevant CPGs for stroke rehabilitation in LMICs to improve implementation/translation into clinical practice.
减轻中风负担的努力一直是一项巨大的挑战。一个重要原因可能是为低收入和中等收入国家（LMICs）制定的中风康复临床实践指南（CPGs）的范围和质量，限制了其在临床实践中的应用。本系统评价旨在评估LMICs中中风康复CPGs的可用性、范围和质量。
遵循PRISMA指南，在四个主要电子数据库（Medline、Embase、CINAHL和PEDro）中检索LMICs中中风康复的CPGs。从灰色文献以及对手检关键书目和搜索引擎中识别出其他研究。对CPGs的可用性和内容进行叙述性总结，并使用“指南研究与评价评估”（AGREE）工具（第二版和卓越推荐（REX）版）分析新制定的CPGs的质量。对非新制定的CPGs的情境化/改编特征进行叙述性总结。
纳入了来自10个国家的12份CPGs。来自巴基斯坦、斯里兰卡、印度和中国的CPGs是新制定的。来自肯尼亚、菲律宾、南非、喀麦隆、蒙古和乌克兰的CPGs是根据高收入国家的现有指南进行情境化/改编的。大多数情境化的CPGs中利益相关者的参与、当地卫生系统/患者路径分析有限。所有10个国家都包括了中风后物理治疗的建议，7个国家包括了沟通、吞咽方面的建议，5个国家包括了职业治疗服务方面的建议。使用AGREE-REX和AGREE-II对新制定指南进行的质量评估较差，尤其是在制定和适用性方面得分较低。
LMICs中针对中风康复的情境化CPGs很少，且不符合要求的质量。需要为LMICs制定针对具体情境、与文化相关的中风康复CPGs，以改善其在临床实践中的实施/应用。
