Comparative global analysis of stroke rehabilitation recommendations across income levels

• Published in: Journal of clinical epidemiology 2024-06, Vol.170, p.111334, Article 111334
• Main Authors: Rodríguez-Orozco, Jaime Eduardo, Martínez-Rubio, Carlos Fernando, Moreno-Vargas, Eder, Peña-Ortiz, Angélica, Pizarro-Peñaranda, María Catalina, Rojo-Bustamante, Estefanía, Villarreal-García, Daniel Eduardo, Bayona-Ortiz, Hernán Francisco
• Format: Article
• Language: English
• Subjects: Availability; Clinical medicine; Clinical practice guidelines; Criteria; Developing countries; Documents; Ethics; GNI; Gross National Income; Guidelines; High income; Income; Industrialized nations; LDCs; Low income areas; Neurological rehabilitation; Quality assessment; Quality control; Quality improvement; Quality standards; Rehabilitation; Search engines; Socioeconomic factors; Stroke; Stroke rehabilitation; Systematic review
• ISSN: 0895-4356; 1878-5921; 1878-5921
• DOI: 10.1016/j.jclinepi.2024.111334

Successful implementation of stroke rehabilitation guidelines demands high-quality practice standards tailored to targeted sociodemographic contexts. The primary objective is to determine the quality differences in post-stroke rehabilitation practice guidelines (PGs), when comparing high-income countries (HIC) and low or middle-income countries (LMIC). We conducted a scoping review of PGs in English or Spanish, published between 2012 and 2021, and providing recommendations on post-stroke rehabilitation. We used Search engines, databases, guideline libraries, gray literature, and references from previous reviews on post-stroke rehabilitation as sources of evidence. Quality assessment of PGs was performed using 6P’s, ELSE, IOM, and AGREE II instruments. We evaluated each item using a scale between 0 to 3, based on the confidence of adherence to the standard. For AGREE II, we followed the instruction manual for scoring. At least two reviewers were independently involved in every step of the process. A cloud-based spreadsheet was used to chart data. We compared the results of PGs originating from HIC with those from LMIC. The inclusion criteria were met by 35 documents, which were subjected to evaluation. The study included 21 documents from HIC and 14 from middle-income countries (MIC). No manuscripts from low-income countries were available for inclusion in the study. The quality of PGs from MIC was found to be lower, in terms of methodological rigor and adherence to international recommendations for guidelines development. PGs from both groups of countries failed to include all target audiences and stakeholders (according to the 6P’s criteria) and integration of ethical, legal, social, and economic considerations. There are gaps in the quality and availability of stroke rehabilitation guidelines worldwide, especially in LMIC. Designing and providing financial support for the implementation of high-quality guidelines will contribute to more effective implementation strategies in stroke rehabilitation programs and lead to improved patient outcomes. •Extensive search for guidelines in English and Spanish.•Multiple quality measures were used in stroke rehabilitation guidelines.•A comparison of guidelines based on country resources was made.