Overview of Cochrane Systematic Reviews as a methodological tool to introduce Cochrane evidence in WHO guidelines: the Cochrane Rehabilitation experience

Article type
Authors
Michele P1, Arienti C1, Lazzarini SG1, Gimigliano F2, Kiekens C3, Negrini S4
1IRCCS Fondazione Don Carlo Gnocchi, Milan
2Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples
3University Hospital, KU Leuven
4Department of Clinical and Experimental Sciences, University of Brescia
Abstract
Background: the World Health Organization (WHO), following its 'Rehabilitation 2030: a call for action', launched a process to develop the Package of Rehabilitation Intervention (PRI), a minimum set to be proposed to all Health Ministries to achieve Universal Health Coverage, a WHO strategic priority. Cochrane Rehabilitation has been involved in developing the methodology of the PRI, and in providing the relevant Cochrane Evidence. Overviews of systematic reviews are a new methodology to synthesise the results of multiple systematic reviews. Since PRI is produced for different health interventions, overviews of Cochrane Systematic Reviews (CSR) are a good tool to introduce Cochrane evidence in the PRI.

Objectives: the aim is to present the methodology developed to answer to the requests of WHO in the development of PRI.

Methods: the main health condition studied has been stroke. The literature search used was the 'tagging process' of Cochrane Rehabilitation as reported by Levack et al (Archives of Physical Medicine and Rehabilitation, 2019). We limited the search to the last 10 years. The review authors collected for each CSR author, publication year, title, date of search, number of included studies (number of participants), population, setting, intervention, control, outcome, corresponding risk (95% CI), relative effect (95% CI), quality of evidence (GRADE), statistical method, heterogeneity, upgrade or downgrade motivation. Where not available in the original CSR, we prepared 'Summary of findings' tables with GRADE evaluation.

Results: we found 62 CSRs (to September 2018): 33 had GRADE evaluation and 29 did not. The study is still ongoing: we will provide final results to the WHO in April 2019 and reported them at the Colloquium.

Conclusions: this study will provide recommendations on stroke rehabilitation, for different outcomes, based on Cochrane evidence.

Patient or healthcare consumer involvement: not applicable