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Contextualized Clinical Practice Guidelines for Post-Stroke Motor Rehabilitation in India: Framework and Endorsement
Objectives:
To develop an evidence-based, contextually relevant clinical practice guideline (CPG) for motor rehabilitation across the stroke continuum in India, identify priority recommendations for implementation, and evaluate the feasibility of its implementation.
Design:
A three-phase mixed-methods study integrating a scoping review, focus group discussions, and systematic guideline synthesis.
Setting:
India, across tertiary, secondary, and community-based rehabilitation settings.
Participants:
Rehabilitation professionals (neurologists, physiatrists, physiotherapists, occupational therapists, nurses, social workers) with ≥10 years' experience, persons with lived experience of stroke, and stakeholders including policymakers, researchers, and administrators.
Main Outcome Measures:
Development of contextually relevant CPG recommendations and their classification based on the strength of evidence and implementation feasibility.
Results:
Rehabilitation pathways were fragmented, with limited access post-discharge and no standardized referral systems. Sixty clinical questions were refined into nine PICO questions and two practice points. A total of 84 recommendations were synthesized from high-quality international guidelines (AGREE-II/REX ≥60%). Using a modified Alper tool, 50 recommendations supported interventions, 13 advised against routine use, and others had limited or unclear evidence. Feasibility assessment using the Adopt-Contextualize-Adapt (ACA) framework showed 39 recommendations suitable for adoption, 32 requiring contextualization, and 13 requiring adaptation. Key domains included motor recovery, activities of daily living, quality of life, complication prevention, therapy dosage, and caregiver involvement.
Conclusions:
This study developed a stakeholder-informed, contextually adapted stroke rehabilitation CPG for India. The guideline provides a scalable framework to improve rehabilitation quality and access, with potential applicability to other low- and middle-income countries.