Henry Leah, Leahy Siobhan, McCurtin Arlene, Boland Pauline
School of Allied Health, University of Limerick, Limerick, Ireland.
Health Research Institute.
Br J Occup Ther. 2022 Dec;85(12):923-946. doi: 10.1177/03080226221107768. Epub 2022 Jun 24.
Self-management post-stroke is essential where healthcare systems are stretched and stroke prevalence remains high. Self-management is recommended in stroke guidelines however, the quality of guidelines can vary and the evidence underpinning recommendations is unclear. The objectives of this paper are to identify and appraise current stroke guidelines, synthesise self-management recommendations and assess the evidentiary basis of these recommendations.
Stroke guidelines were retrieved from a search of four databases and stroke association websites in July 2021. Four independent reviewers assessed their quality using the Appraisal of Guidelines Research and Evaluation 2nd Edition instrument. Self-management recommendations were extracted by hand, evaluated, synthesised and the evidence underpinning them appraised using the Canadian Stroke Best Practice Recommendations framework.
Eleven guidelines were included in this systematic review, all of excellent methodological quality overall. One hundred and sixty-one recommendations were extracted from these guidelines and grouped into ten principles of self-management. A quarter of the recommendations were underpinned by level A evidence, 32% level B and 43% level C.
Although current stroke guidelines are of high methodological quality, there are considerable inconsistencies in self-management recommendations within and between these guidelines, with varying strengths of underpinning evidence. This article identifies a need for universal consensus regarding evidence-based self-management post-stroke.
在医疗系统不堪重负且中风患病率居高不下的情况下，中风后的自我管理至关重要。中风指南推荐进行自我管理，然而，指南的质量可能参差不齐，且支撑这些推荐的证据并不明确。本文的目的是识别和评估当前的中风指南，综合自我管理推荐意见，并评估这些推荐意见的证据基础。
2021年7月，通过检索四个数据库和中风协会网站获取中风指南。四名独立评审员使用《指南研究与评价第2版》工具评估其质量。通过人工提取自我管理推荐意见，进行评估、综合，并使用加拿大中风最佳实践推荐框架评估其支撑证据。
本系统评价纳入了11项指南，总体方法学质量均为优秀。从这些指南中提取了161条推荐意见，并归纳为自我管理的十条原则。四分之一的推荐意见有A级证据支持，32%有B级证据支持，43%有C级证据支持。
尽管当前的中风指南方法学质量较高，但这些指南内部以及相互之间在自我管理推荐意见方面存在相当大的不一致性，支撑证据的力度也各不相同。本文指出需要就中风后基于证据的自我管理达成普遍共识。
