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.

Tuesday, June 10, 2025

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

Big fucking whoopee.

Guidelines; NOT PROTOCOLS! Guidelines don't guarantee recovery; properly constructed protocols do!

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* and 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

Edited by

Nicola Smania, University of Verona, Italy

Reviewed by

Valentina Varalta, University of Verona, Italy

Daniela Burguêz, Hospital São Lucas da PUCRS, Brazil

*Correspondence

Ling Tang, tangling@zxyjhhl.org.cn; Ying-Hui Jin, jinyinghuiebm@163.com

Received 28 February 2025

Accepted 26 May 2025

Published 09 June 2025

Citation

Li Y, Zhang J, Li J-j, Zhao D, Tang L and Jin Y-H (2025) An evidence map of clinical practice guideline recommendations and quality of non-pharmaceutical interventions for post-stroke emotional disorders. Front. Neurol. 16:1580799. doi: 10.3389/fneur.2025.1580799

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.

Keywords

cerebral stroke; emotional disorder; non-pharmacological intervention; clinical practice guidelines; evidence-based medicine

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.

2 Materials and methods

2.1 Search strategy

We systematically searched the following databases: PubMed, Web of Science, Embase, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, SinoMed, YiMaiTong. We also hand-searched 6 databases of international guideline developing institutions: Guideline International Network (GIN), Registered Nurses’ Association of Ontario (RNAO), Scottish Intercollegate Guidelines Network (SIGN), National Institute for Health and Care Excellence (NICE), National Guideline Clearinghouse (NGC), and New Zealand Guidelines Group (NZGG). Articles were retrieved by combining subject terms and free terms, from origin to November 20, 2024. The full search strategies are shown in Supplementary material 1.

2.2 Study selection

In our study, the inclusion criteria were: guidelines which provided recommendations regarding NPIs for PSED and included access to the full text. Both evidence-based clinical practice guidelines and consensus-based clinical practice guidelines (EB-CPGs and CB-CPGs) were included, and the guidelines had to at least contain details of evidence retrieval and literature evaluation. We have described both consensus statements and expert opinions as CB-CPGs (11). The CPGs had to include NPIs for PSED. The most commonly included NPIs were: psychotherapy, social support therapy, traditional Chinese medicine non-pharmacological therapies, and physical therapy (12). If guidelines were available in multiple languages (such as English and Chinese), only the version in the original language was eligible for inclusion. In cases of updated guidelines, only the most recent version was considered. Exclusion criteria were editorial or correspondence articles that summarized organizational clinical practice guidelines.