Article type
Year
Abstract
Background:
Clinicians rightly look to guidelines to help inform the care they offer, thus providing best practice and evidence-based medicine to their patients. To do this effectively they rely upon clinical practice guidelines (CPGs), which in turn are inherently contingent on the evidence of the studies they drawn on to make their recommendations.
Objectives:
To look at relevant CPGs, and the quality of evidence used by those CPGs to make their recommendations to facilitate the production of a easy to view homogenized synthesized meta-analysis of all recommendations and the quality of evidence they rest on.
Methods:
An information specialist & I conducted a literature search on 28th February 2019 pertaining to cognitive assessment in stroke patients covering the Medline, Embase, and Cinahl & PsycInfo databases.
Thereafter, 2 independent reviewers screened & performed data extraction of eligible records as described in our prior constructed PICO statement (facilitating predetermined unbiased inclusion criteria).
Subsequently these were AGREE-II scored, a widely used standard for assessing the methodological quality of CPGs, by 2 independent raters.
Guidelines were ‘high quality’ if addressing at least four of the six AGREE II-domains, including rigour of development. Likewise, if two or more were addressed, except ‘Rigour of Development' they were ‘moderate quality’ and when no domain was adequately addressed they were of ‘low’ overall quality.
Results:
As per AGREE-II there was 6 high quality CPGs i.e Royal college Physicians (RCP), Scottish intercollegiate guideline network (SIGN) (both stroke & dysphagia guidelines), Australian, Canadian and NICE guidelines (national institute of clinical excellence), while the Irish CPG was rated moderate quality.
NICE & Australian CPGs used GRADE for recommendations; SIGN utilizes an A-D rating, likewise does the Canadian CPG & the RCP uses a working party consensus system. The Irish guidelines are a composite of the others.
All CPGs recommend cognitive assessment despite deficiency of primary studies, with unanimous consensus on using a validated screening tool (one CPG explicitly suggests the MOCA).
During rehabilitation cognitive assessment is recommended for all patients regardless of baseline, and assessments should be performed by qualified individuals taking into account patient dysphasia. Consideration of depression screening is advised when cognitive deficits are found.
Conclusions:
Internationally CPGs agree on performing cognitive assessment in stroke patients. Again consensus on using validated tools is found, although several are mentioned, and consideration of mood on cognition is mentioned. However the evidence to assert these is predominantly expert opinion, itself underscoring paucity of primary research on this matter. This has hindered the production of a gold standard ‘forest plot’ and instead meant we have opted to present the data in a color coded table as per AGREE scoring instead to aid rapid appraisal by clinicians.
Clinicians rightly look to guidelines to help inform the care they offer, thus providing best practice and evidence-based medicine to their patients. To do this effectively they rely upon clinical practice guidelines (CPGs), which in turn are inherently contingent on the evidence of the studies they drawn on to make their recommendations.
Objectives:
To look at relevant CPGs, and the quality of evidence used by those CPGs to make their recommendations to facilitate the production of a easy to view homogenized synthesized meta-analysis of all recommendations and the quality of evidence they rest on.
Methods:
An information specialist & I conducted a literature search on 28th February 2019 pertaining to cognitive assessment in stroke patients covering the Medline, Embase, and Cinahl & PsycInfo databases.
Thereafter, 2 independent reviewers screened & performed data extraction of eligible records as described in our prior constructed PICO statement (facilitating predetermined unbiased inclusion criteria).
Subsequently these were AGREE-II scored, a widely used standard for assessing the methodological quality of CPGs, by 2 independent raters.
Guidelines were ‘high quality’ if addressing at least four of the six AGREE II-domains, including rigour of development. Likewise, if two or more were addressed, except ‘Rigour of Development' they were ‘moderate quality’ and when no domain was adequately addressed they were of ‘low’ overall quality.
Results:
As per AGREE-II there was 6 high quality CPGs i.e Royal college Physicians (RCP), Scottish intercollegiate guideline network (SIGN) (both stroke & dysphagia guidelines), Australian, Canadian and NICE guidelines (national institute of clinical excellence), while the Irish CPG was rated moderate quality.
NICE & Australian CPGs used GRADE for recommendations; SIGN utilizes an A-D rating, likewise does the Canadian CPG & the RCP uses a working party consensus system. The Irish guidelines are a composite of the others.
All CPGs recommend cognitive assessment despite deficiency of primary studies, with unanimous consensus on using a validated screening tool (one CPG explicitly suggests the MOCA).
During rehabilitation cognitive assessment is recommended for all patients regardless of baseline, and assessments should be performed by qualified individuals taking into account patient dysphasia. Consideration of depression screening is advised when cognitive deficits are found.
Conclusions:
Internationally CPGs agree on performing cognitive assessment in stroke patients. Again consensus on using validated tools is found, although several are mentioned, and consideration of mood on cognition is mentioned. However the evidence to assert these is predominantly expert opinion, itself underscoring paucity of primary research on this matter. This has hindered the production of a gold standard ‘forest plot’ and instead meant we have opted to present the data in a color coded table as per AGREE scoring instead to aid rapid appraisal by clinicians.