Deans' stroke musings: An evidence map of clinical practice guideline recommendations and quality of non-pharmaceutical interventions for post-stroke emotional disorders

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, June 25, 2025

An evidence map of clinical practice guideline recommendations and quality of non-pharmaceutical interventions for post-stroke emotional disorders

Needing to treat emotional disorders is a sign of complete incompetence to 100% recovery!

An evidence map of clinical practice guideline recommendations and quality of non-pharmaceutical interventions for post-stroke emotional disorders

Ye Li¹

Jing Zhang²

Jia-ji Li¹

Dan Zhao¹

Ling Tang¹^*

Ying-Hui Jin³^*

¹Nursing Department of Dong fang Hospital, Beijing University of Chinese Medicine, Beijing, China
²Department of Neurosurgery, Handan Central Hospital, Handan, China
³Center for Evidence-Based and Translational Medicine, Zhong nan Hospital of Wuhan University, Wuhan, Hubei, China

Background: Clinical practice guidelines (CPGs) have an indispensable role in guiding the selection of various non-pharmaceutical interventions (NPIs) for post-stroke emotional disorders (PSED). However, little is known about their quality and recommendations. This study aims to critically appraise the quality of existing NPIs for PSED CPGs and extract relevant recommendations, present the research distribution of various NPIs in an evidence map, and assist clinicians in making decisions.

Methods: A systematic search was undertaken in PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure, Wanfang, VIP, SinoMed, and international guideline developing institutions from origin to November 20, 2024, to identify the CPGs on NPIs for PSED. The CPGs finally selected were blindly evaluated by two reviewers using the Appraisal of Guidelines Research & Evaluation (AGREE) II instrument and the reporting quality was evaluated using the RIGHT statement. The overall agreement among reviewers was analyzed using intraclass correlation coefficient (ICC).

Results: Nine guidelines were included and evaluated. Two CPGs were grade A (recommended) and seven CPGs were grade B (recommended with modification). The reporting rate of RIGHT ranged from 40.00 to 80.00%. Nine NPIs were extracted, and there were similarities and differences between the recommendations.

Conclusion: This study provides specific direction for improving the quality of CPGs for NPIs for PSED, and provides useful information for clinicians and stakeholders, and provides a basis for clinical decision-making.

1 Introduction

Cerebral stroke is the second largest cause of death worldwide, accounting for 11.6% of the total number of deaths (1). It is characterized by a high incidence, high recurrence rate, high disability rate and high mortality rate, leading to an increased burden of disease around the world (1). Post-stroke emotional disorder (PSED) is one of the most common and serious complications, commonly occurring at all stages of the disease and its pathogenesis is still unclear (2). It includes post stroke depression (PSD), post-stroke anxiety (PSA), post-stroke comorbid anxiety and depression (PSCAD), post-stroke emotional imbalance (PSEI) and post-stroke anger proneness (PSAP) (3). Approximately one-third of stroke survivors develop some form of emotional disorder (2–4). Studies have shown (5, 6) that emotional disorders are closely related to patients’ prognosis. If patients are not treated in time, it will affect the recovery of neurological function and the ability to return to society, and even lead to increased mortality. There is no universally effective method for the treatment of PSED, and although drug therapy has a certain effect, there are many side effects (7). Some systematic reviews and meta-analyses have shown that non-pharmaceutical interventions (NPIs) can effectively reduce emotional symptoms and improve patient’s quality of life (7–9). Many authoritative organizations have issued a number of CPGs related to the treatment and rehabilitation of Stroke, which contain NPIs to help health care workers and patients to make local health care decisions (10).

The purpose of this study is to evaluate the quality of guidelines related to NPIs for PSED, to make relevant recommendations for NPIs use in PSED, to provide information for standardized practice and management, to identify potential directions that CPGs should focus on in the future, and to provide a reference for relevant policy development and clinical practice.