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. 2023 Oct;18(9):1029-1039.
doi: 10.1177/17474930231161454. Epub 2023 Mar 9.

An updated systematic review of stroke clinical practice guidelines to inform aphasia management

Bridget Burton  1   2   3   4 , Megan Isaacs  1   2   3   4 , Emily Brogan  3   5   6 , Kirstine Shrubsole  1   2   3   4 , Monique F Kilkenny  3   7   8 , Emma Power  3   9 , Erin Godecke  3   5   6 , Dominique A Cadilhac  3   7   8 , David Copland  1   2   3   4 , Sarah J Wallace  1   2   3   4
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An updated systematic review of stroke clinical practice guidelines to inform aphasia management

Bridget Burton et al. Int J Stroke. 2023 Oct.

Abstract

Background: Aphasia is a common consequence of stroke, and people who live with this condition experience poor outcomes. Adherence to clinical practice guidelines can promote high-quality service delivery and optimize patient outcomes. However, there are currently no high-quality guidelines specific to post-stroke aphasia management.

Aims: To identify and evaluate recommendations from high-quality stroke guidelines that can inform aphasia management.

Summary of review: We conducted an updated systematic review in accordance with PRISMA guidelines to identify high-quality clinical guidelines published between January 2015 and October 2022. Primary searches were performed using electronic databases: PubMed, EMBASE, CINAHL, and Web of Science. Gray literature searches were conducted using Google Scholar, guideline databases, and stroke websites. Clinical practice guidelines were evaluated using the Appraisal of Guidelines and Research and Evaluation (AGREE II) tool. Recommendations were extracted from high-quality guidelines (scored > 66.7% on Domain 3: "Rigor of Development"), classified as aphasia-specific or aphasia-related, and categorized into clinical practice areas. Evidence ratings and source citations were assessed, and similar recommendations were grouped. Twenty-three stroke clinical practice guidelines were identified and 9 (39%) met our criteria for rigor of development. From these guidelines, 82 recommendations for aphasia management were extracted: 31 were aphasia-specific, 51 aphasia-related, 67 evidence-based, and 15 consensus-based.

Conclusion: More than half of stroke clinical practice guidelines identified did not meet our criteria for rigorous development. We identified 9 high-quality guidelines and 82 recommendations to inform aphasia management. Most recommendations were aphasia-related; aphasia-specific recommendation gaps were identified in three clinical practice areas: "accessing community supports," "return to work, leisure, driving," and "interprofessional practice."

Keywords: Aphasia; practice guidelines; rehabilitation; speech–language pathology; stroke.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: E.G., E.B., K.S., and E.P. are current members of the speech pathology working group for the Australian Stroke Foundation—Clinical Guidelines for Stroke Management. D.C. is a current member of the Australian Stroke Foundation—Clinical Guidelines for Stroke Management Steering Committee. During this research, E.P. was on the Research Advisory Committee of the Stroke Foundation. E.G. was an expert panel member in development of the Australian Aphasia Rehabilitation Pathway Best Practice Statements. E.P. led the expert panel on the Australian Aphasia Rehabilitation Pathway Best Practice Statements.

Figures

Figure 1.
Figure 1.
Clinical practice guideline selection process (PRISMA).
Figure 2.
Figure 2.
Best practice aphasia management after stroke: An overview.
See this image and copyright information in PMC

References

    1. Mitchell C, Gittins M, Tyson S, et al.. Prevalence of aphasia and dysarthria among inpatient stroke survivors: describing the population, therapy provision and outcomes on discharge. Aphasiology 2020; 35: 950–960.
    1. Mitchell AJ, Sheth B, Gill J, et al.. Prevalence and predictors of post-stroke mood disorders: a meta-analysis and meta-regression of depression, anxiety and adjustment disorder. Gen Hosp Psychiatry 2017; 47: 48–60. - PubMed
    1. Brady MC, Kelly H, Godwin J, et al.. Speech and language therapy for aphasia following stroke. Cochrane Database Syst Rev 2016; 2016: CD000425. - PMC - PubMed
    1. Woolf SH, Grol R, Hutchinson A, et al.. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ 1999; 318: 527–530. - PMC - PubMed
    1. Hubbard IJ, Harris D, Kilkenny MF, Faux SG, Pollack MR, Cadilhac DA. Adherence to clinical guidelines improves patient outcomes in Australian audit of stroke rehabilitation practice. Arch Phys Med Rehabil 2012; 93: 965–971. - PubMed

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