http://www.tandfonline.com/doi/abs/10.1080/02687038.2016.1143083
- DOI:
- 10.1080/02687038.2016.1143083
- Received: 18 Mar 2015
- Accepted: 12 Jan 2016
- Published online: 17 Feb 2016
Abstract
Background:
Clinical practice guidelines (CPGs) have been shown to improve patient
care and outcomes. For speech pathologists working with people with
post-stroke aphasia, there is currently no single high-quality guideline
that summarises all of the available research knowledge into
recommendations to guide decision-making. While multiple stroke and
aphasia guidelines exist, some are of low methodological quality, are
out of date, or do not provide recommendations that specifically guide
aphasia management. As such, it may be difficult for clinicians to
choose one particular guideline to follow.
Aim:
To identify, extract, and evaluate recommendations from high-quality
CPGs to inform the management of post-stroke aphasia by speech
pathologists.
Methods & Procedures:
An updated systematic review of stroke and speech pathology-specific
clinical guidelines was conducted in January 2015. The search included
multiple databases (MEDLINE, Embase, CINAHL), guideline and stroke
websites, and other sources. The quality of included guidelines was
assessed using the Appraisal of Guidelines and Research and Evaluation
(AGREE) II tool. Guidelines that obtained a high AGREE II “Rigour of
Development” score were retained and the aphasia-relevant
recommendations from these guidelines were extracted for further
analysis. Recommendations were evaluated according to their
applicability to aphasia and the clarity of linkages between the
recommendations and underlying evidence.
Outcomes & Results:
Five new guidelines were identified. Their AGREE II ratings ranged from
31.3 to 71.9, and one met the cut-off of 66.67 for further analysis.
One hundred and eleven recommendations from four guidelines were
extracted and evaluated. From these, 76 recommendations met the
inclusion criteria, 25 of which were specifically targeted at aphasia
management, the remainder being general rehabilitation principles that
may apply to aphasia. Thirty-four recommendations were directly linked
to evidence, and 42 were based on consensus. Research gaps were noted
for goal-setting, counselling, patient and carer support, and discharge
planning, indicating possible areas for future research. There were
challenges in comparing recommendations from different CPGs, determining
whether evidence was applicable to people with aphasia, and in
identifying clear links between the evidence and some recommendations.
Conclusions:
The collated 76 (34 evidence-based, 42 consensus-based) recommendations
can be used by speech pathologists to guide aphasia rehabilitation.
Aphasia-specific research is required in areas such as goal-setting,
counselling, patient and carer support, and discharge planning.
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