Article type
Abstract
Background
Clinical practice guidelines (CPGs) are crucial in health care because they directly provide recommendations to clinicians and decision-makers. High-quality CPGs can improve health care decisions and outcomes when they are rigorously developed and reported. Low- and medium-income countries (LMICs) bear the highest burden of stroke globally. Interventions to address the stroke burden in LMICs have faced enormous challenges, and good-quality CPGs may improve health outcomes and clinical practice.
Objective
To assess the reporting of de novo and adapted stroke CPGs emanating from LMICs.
Methods
This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Medline, Guideline International Network database, Cochrane Central Register of Controlled Trials, CINAHL, and PEDro databases were searched from inception until December 2023. Two reviewers independently screened the retrieved titles. All conflicts were resolved with a third reviewer. All de novo CPGs were assessed using the RIGHT statements, and RIGHT-Ad@pt was used for adapted or contextualized CPGs.
Results
This review identified and included 10 CPGs from 9 countries for stroke management and rehabilitation. Three de novo CPGs came from India, Pakistan, and Sri Lanka. Two scored moderately well on the RIGHT checklist, with 1 having overall poor scores. All 3 de novo CPGs scored poorly on review and quality assurance, funding, and declaration and management of interest. Seven CPGs from 6 countries, namely Cameroon, Kenya, Mongolia, Philippines, South Africa, and Ukraine, were adapted or contextualized from CPGs from high-income countries. Five of the 7 scored well on the rigor of development, and 42.85% scored poorly on external review, quality assurance, funding, and declaration and management of interest. Both de novo and contextualization processes needed more stakeholder involvement or local health systems and patient pathway analysis.
Conclusion
De novo, adapted, and contextualized CPGs for stroke care were barely available from LMICs. Existing CPGs still need to meet the required quality in several domains, with the majority needing implementation plans. There is a need to increase CPG development awareness, capacity, and rigor in LMICs.
Clinical practice guidelines (CPGs) are crucial in health care because they directly provide recommendations to clinicians and decision-makers. High-quality CPGs can improve health care decisions and outcomes when they are rigorously developed and reported. Low- and medium-income countries (LMICs) bear the highest burden of stroke globally. Interventions to address the stroke burden in LMICs have faced enormous challenges, and good-quality CPGs may improve health outcomes and clinical practice.
Objective
To assess the reporting of de novo and adapted stroke CPGs emanating from LMICs.
Methods
This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Medline, Guideline International Network database, Cochrane Central Register of Controlled Trials, CINAHL, and PEDro databases were searched from inception until December 2023. Two reviewers independently screened the retrieved titles. All conflicts were resolved with a third reviewer. All de novo CPGs were assessed using the RIGHT statements, and RIGHT-Ad@pt was used for adapted or contextualized CPGs.
Results
This review identified and included 10 CPGs from 9 countries for stroke management and rehabilitation. Three de novo CPGs came from India, Pakistan, and Sri Lanka. Two scored moderately well on the RIGHT checklist, with 1 having overall poor scores. All 3 de novo CPGs scored poorly on review and quality assurance, funding, and declaration and management of interest. Seven CPGs from 6 countries, namely Cameroon, Kenya, Mongolia, Philippines, South Africa, and Ukraine, were adapted or contextualized from CPGs from high-income countries. Five of the 7 scored well on the rigor of development, and 42.85% scored poorly on external review, quality assurance, funding, and declaration and management of interest. Both de novo and contextualization processes needed more stakeholder involvement or local health systems and patient pathway analysis.
Conclusion
De novo, adapted, and contextualized CPGs for stroke care were barely available from LMICs. Existing CPGs still need to meet the required quality in several domains, with the majority needing implementation plans. There is a need to increase CPG development awareness, capacity, and rigor in LMICs.