Standardising evidence strength grading for recommendations from multiple clinical practice guidelines: a South...

Area of Science:

• Health Services Research
• Rehabilitation Medicine
• Evidence Synthesis

Background:

• Developing clinical practice guidelines (CPGs) requires significant resources, posing challenges for resource-constrained countries.
• International CPGs offer potential efficiencies for countries lacking resources for de novo guideline development.
• This paper details a novel process for synthesizing international allied health (AH) stroke rehabilitation CPGs in South Africa.

Purpose of the Study:

• To outline and test a novel process for synthesizing existing international CPGs for allied health (AH) stroke rehabilitation in a resource-constrained setting.
• To adapt international best practices for stroke rehabilitation to the South African healthcare context.
• To provide an efficient alternative to de novo CPG development.

Main Methods:

• A collaborative approach involving methodologists, policymakers, content experts, and consumers to define patient pathways and identify research questions.
• A systematic search and critical appraisal of international CPGs published since 2010.
• Extraction and synthesis of recommendations, standardization of Strength of Body of Evidence (SoBE) gradings, and development of composite recommendations.

Main Results:

• Sixteen international CPGs were identified and included, addressing various aspects of stroke rehabilitation.
• Seven clusters of composite recommendations were developed, covering the continuum of stroke care from acute admission to community-based rehabilitation.
• Methodological quality varied among the included CPGs, with no clear correlation to publication currency.

Conclusions:

• The developed methodological process for guideline synthesis is efficient, collaborative, and effective.
• This approach significantly reduces the time and cost associated with developing de novo CPGs.
• The process is adaptable for use in other resource-constrained countries seeking to improve stroke rehabilitation guidelines.