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Systematic review of clinical practice guidelines to identify recommendations for rehabilitation after stroke and other acquired brain injuries
  1. Laura Jolliffe1,
  2. Natasha A Lannin1,2,3,
  3. Dominique A Cadilhac4,5,
  4. Tammy Hoffmann6
  1. 1 Discipline of Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
  2. 2 Occupational Therapy Department, Alfred Health, Prahran, Australia
  3. 3 John Walsh Centre for Rehabilitation Research, Sydney Medical School (Northern), The University of Sydney, Sydney, Australia
  4. 4 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
  5. 5 The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
  6. 6 Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
  1. Correspondence to Dr Natasha A Lannin; n.lannin{at}


Objectives Rehabilitation clinical practice guidelines (CPGs) contain recommendation statements aimed at optimising care for adults with stroke and other brain injury. The aim of this study was to determine the quality, scope and consistency of CPG recommendations for rehabilitation covering the acquired brain injury populations.

Design Systematic review.

Interventions Included CPGs contained recommendations for inpatient rehabilitation or community rehabilitation for adults with an acquired brain injury diagnosis (stroke, traumatic or other non-progressive acquired brain impairments). Electronic databases (n=2), guideline organisations (n=4) and websites of professional societies (n=17) were searched up to November 2017. Two independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and textual syntheses were used to appraise and compare recommendations.

Results From 427 papers screened, 20 guidelines met the inclusion criteria. Only three guidelines were rated high (>75%) across all domains of AGREE-II; highest rated domains were ‘scope and purpose’ (85.1, SD 18.3) and ‘clarity’ (76.2%, SD 20.5). Recommendations for assessment and for motor therapies were most commonly reported, however, varied in the level of detail across guidelines.

Conclusion Rehabilitation CPGs were consistent in scope, suggesting little difference in rehabilitation approaches between vascular and traumatic brain injury. There was, however, variability in included studies and methodological quality.

PROSPERO registration number CRD42016026936.

  • rehabilitation
  • practice guideline
  • stroke
  • evaluation
  • brain injury

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  • Contributors All authors made substantial contribution to the design of the work. LJ, NAL and TH completed PROSPERO trial registration. NAL and LJ completed the search as per search strategy. LJ completed screening and full-text review. LJ and NAL completed AGREE-II ratings for included guidelines. All authors made significant contribution to the interpretation of data and drafting the work or revising it critically for important intellectual content. They provided final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding LJ was supported by a postgraduate fellowship from the National Health and Medical Research Council (NHMRC; GNT 1114522); NAL was supported by NHMRC Translating Research Into Practice fellowship (GNT 1112158); DAC was supported by a National Heart Foundation/NHMRC Future Leader fellowship (GNT 1063761).

  • Competing interests NAL, TH and DAC have been involved in the development of clinical practice guidelines referenced in this paper. They have also authored papers (randomised controlled trials) cited within the body of the guidelines that this systematic review appraised.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional, unpublished data arising from this research.

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