Article type
Abstract
Background: A significant amount of the stroke burden globally is borne by low- and middle-income countries (LMICs). However, efforts toward reducing the stroke burden in this context have faced immense challenges. One reason is because of the scope and quality of clinical practice guidelines (CPGs) developed for stroke rehabilitation in the LMICs, influencing their translation to clinical practice.
Objective: To assess the availability, scope, and quality of CPGs for stroke rehabilitation in LMICs.
Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension (PRISMA) guidelines. Four major electronic databases (Medline, EMBASE, CINAHL and PEDro) were searched using keywords and search strings related to the review's objective. Two reviewers independently screened the titles, abstracts, and full texts and conducted data extraction. All conflicts were resolved with a third reviewer. Availability and the content of the CPGs were synthesized and summarized narratively. The quality of the included CPGs were assessed using the AGREE REX and AGREE II tools.
Results: This review identified and included 11 CPGs from nine countries for stroke rehabilitation. Guidelines from three countries, Pakistan, Sri Lanka, and India, were developed de novo. Guidelines from six countries, namely Kenya, the Philippines, South Africa, Cameroon, Mongolia, and Ukraine, were developed based on CPGs from high-income countries but contextualized with features of contextualization summarized. Most contextualization had limited stakeholder involvement, local health systems, or patient pathway analysis. All nine countries have included recommendations for physiotherapy, seven for communication and swallowing, and five for occupational therapy services post-stroke. Quality assessment using AGREE REX and AGREE II for the included de novo guidelines was poor. Generally, the guidelines scored poorly on the rigor of development and applicability.
Conclusion: Contextualized CPGs for stroke rehabilitation were barely available for LMICs and did not meet the required quality. There is an immense need to develop context-specific, culturally relevant CPGs for stroke rehabilitation in LMICs to improve implementation into clinical practice and subsequent improvement in the quality of stroke rehabilitation and service delivery.
Objective: To assess the availability, scope, and quality of CPGs for stroke rehabilitation in LMICs.
Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension (PRISMA) guidelines. Four major electronic databases (Medline, EMBASE, CINAHL and PEDro) were searched using keywords and search strings related to the review's objective. Two reviewers independently screened the titles, abstracts, and full texts and conducted data extraction. All conflicts were resolved with a third reviewer. Availability and the content of the CPGs were synthesized and summarized narratively. The quality of the included CPGs were assessed using the AGREE REX and AGREE II tools.
Results: This review identified and included 11 CPGs from nine countries for stroke rehabilitation. Guidelines from three countries, Pakistan, Sri Lanka, and India, were developed de novo. Guidelines from six countries, namely Kenya, the Philippines, South Africa, Cameroon, Mongolia, and Ukraine, were developed based on CPGs from high-income countries but contextualized with features of contextualization summarized. Most contextualization had limited stakeholder involvement, local health systems, or patient pathway analysis. All nine countries have included recommendations for physiotherapy, seven for communication and swallowing, and five for occupational therapy services post-stroke. Quality assessment using AGREE REX and AGREE II for the included de novo guidelines was poor. Generally, the guidelines scored poorly on the rigor of development and applicability.
Conclusion: Contextualized CPGs for stroke rehabilitation were barely available for LMICs and did not meet the required quality. There is an immense need to develop context-specific, culturally relevant CPGs for stroke rehabilitation in LMICs to improve implementation into clinical practice and subsequent improvement in the quality of stroke rehabilitation and service delivery.