Evidence-Based Guidelines and Clinical Pathways in Stroke Rehabilitation—An International Perspective

Frontiers in Neurology, 2019 · DOI: 10.3389/fneur.2019.00200 · Published: March 8, 2019

Simple Explanation

Stroke rehabilitation is important for reducing disability after stroke. Guidelines help promote best practices, but creating and updating them is difficult and often focused on high-income countries. International guidelines could help countries develop their own local stroke rehabilitation pathways. The World Federation for NeuroRehabilitation is working on developing such guidelines. These guidelines aim to focus on treatment approaches rather than organizational issues. This could help in structuring regional or local stroke rehabilitation pathways.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Not specified

Key Findings

1
Published stroke rehabilitation guidelines primarily have a national focus and reflect healthcare situations in high-income countries, limiting their applicability in other regions.
2
There is a risk of bias in existing guidelines due to evidence selection, especially in guidelines covering a broad range of topics.
3
International stroke rehabilitation guidelines could provide useful guidance for professionals from diverse healthcare system backgrounds by addressing healthcare questions in a generic way.

Research Summary

The global burden of stroke-related disability is increasing, necessitating effective stroke rehabilitation strategies. Evidence-based guidelines are crucial for promoting best clinical practice in stroke rehabilitation, but their development and implementation face obstacles. International stroke rehabilitation guidelines, such as those being developed by the WFNR, could help countries create local pathways and make the best use of available resources.

Practical Implications

Development of Central Evidence Sources

The development of central evidence sources that comprehensively appraise available evidence and link it to practice recommendations can facilitate the wide-spread development of valid comprehensive up-to-date evidence-based national guidelines.

Creation of International Guidelines

The creation of genuine international evidence-based stroke rehabilitation guidelines that focus on therapeutic approaches rather than organizational issues can be used by many to structure regional or local stroke rehabilitation pathways.

Support for WHO Rehabilitation 2030

This work supports the WHO initiative “Rehabilitation 2030” and its working group that identifies evidence-based rehabilitation interventions suitable for implementation in low and middle income countries.

Study Limitations

1
The review might not have detected all available stroke rehabilitation guidelines.
2
The usefulness of guidelines developed in high-income countries is limited for low- and middle-income countries.
3
There is a risk of bias in existing guidelines due to evidence selection.

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