Systematic review of clinical practice guidelines in the rehabilitation management of stroke: Is it time for an international guideline?

Background: Stroke rehabilitation research is not always implemented in rehabilitation, and variation in practices is acknowledged. Clinical practice guidelines (CPG) aim to facilitate the use of evidence by clinicians, however there are multiple clinical practice guidelines for stroke rehabilitation available and
it is unknown which should be applied in practice. The aim of this study was to determine the quality, scope and consistency of CPG recommendations for rehabilitation after stroke.
Methods: Systematic review of CPGs which contained
recommendations for inpatient or community rehabilitation for adults with stroke. Electronic databases, guideline organisations and websites of professional societies were searched and 2 reviewers rated each guideline on the Appraisal of Guidelines for Research and Evaluation (AGREE) II. Recommendations were synthesised across CPGs to build universal recommendations for rehabilitation after stroke.
Results: N ¼ 427 papers were screened, with n ¼ 15 CPGs providing stroke rehabilitation recommendations in English identified. Few (n ¼ 3) CPGs rated highly across all domains of AGREE-II tool; highest rated domains were ‘scope and purpose’ and ‘clarity’; domain 5 ’applicability’ was rated poorly across guidelines. Recommendations for ‘assessment’ and for ‘motor therapies’ were most commonly provided in CPGs, however, the content of recommendations varied across CPGs which may lead to variations in clinical care.
Conclusion: Multiple CPGs exist to guide stroke rehabilitation, which makes selecting a guideline difficult for clinicians. It is plausible that both the cost efficiency of producing a CPG as well as the quality of the method of development would improve if countries collaborated to produce an international guideline instead of local guidelines.