Introduction
In the recent years, CPGs (Clinical Practice Guidelines) have been widely incorporated into clinical practice to facilitate efficient as well as effective medical practice and improve the care of patients as well as their health outcomes. Essentially, CPGs are statements that are systematically developed mainly to assist healthcare professionals in making the relevant clinical decisions in regard to the suitable healthcare involved in specific clinical issues (Brouwers et al., 2012). As such, CPGs provide clear and succinct instructions on the screening and diagnostic tests that should be ordered in certain clinical circumstances, medical services to be offered, length of stay in the hospital as well as other information pertaining clinical practice. In addition, well-developed CPGs usually promote quality of healthcare particularly by minimizing variations ion healthcare, discouraging ineffective interventions, enhancing diagnostic accuracy as well as promoting the delivery of effective therapy (Shekelle et al., 2012).
However, in some instances, the quality of these CPGs may be inconsistent whereby some usually fall-short of the key basic standards. In regard to this, the AGREE II (Appraisal of Guidelines for Research & Evaluation) instrument is among the most essential tools that has been developed with the aim of addressing the variability or inconsistency issue in respect to the quality of these CPGs (Rohde, Worrall & Le Dorze, 2013). In the light of this, the AGREE II tool offers a framework for evaluating the quality of a CPG, offers the methodological strategy in regard to the development of the CPG and provides the information to be included in the guidelines aimed at enhancing the overall quality of healthcare. As such, this paper seeks to appraise the “Clinical Guidelines for Stroke Management 2010” using the AGREE II instrument and in reference to the case scenario.
Scope of practice
The scope as well as the objectives of this clinical guideline are clearly and specifically described. In this regard, the key objective for this clinical guidelines is to provide a wide variety of evidence-based recommendations pertaining to stroke care as well as management (Boddice et al., 2010). Thus, the CPG focus on providing an overall guide to be used in promoting appropriate practice but should be followed based on the judgement of the clinician as well as the preferences of patients. In regard to the scope, the CPG covers most essential topics in regard to optimal stroke care. As such, the guideline includes various aspects pertaining to stroke care including; acute, pre-hospital, post-acute, secondary prevention of stroke, community care as well as TIA (Transient Ischemic Attack) management. However, the CPG does not cover stroke among infants and children less than eighteen years of age as well as primary prevention of the disease. Overall, the key goal for this CPG is to assist healthcare professionals in enhancing the effectiveness as well as quality of care rendered to stroke patients.
Stakeholder involvement
The development of this guideline involved individuals drawn from the relevant and concerned professional groups. Thus, the development of this guideline involved various professional groups including, government officials, care givers and health professionals. Additionally, the development involved working with various stakeholders including stroke patients, the public, stroke survivors as well as their families. Thus, the development of this guideline sought the preferences as well as views of stroke patients, their caregivers and the entire public. Moreover, the target users for this CPG are well defined. In relation to this, the guideline is meant to be used by the health professionals, funders, administrators and policy makers involved in planning, organizing and care delivery for individuals suffering from stroke in all the recovery phases for stroke as well as TIA. Among the key health professionals who are intended to use this guideline includes; nurses, psychologists, dietitians, social workers, doctors, speech therapists, pharmacists, physiotherapists and occupational therapists.
Rigor of development
Identification and searching for evidence, involved the utilization of comprehensive systematic methods whereby this was based on systematic identification and analysis of the best evidence available in relation to the topic. Thus, the criteria used in selecting the best and most appropriate evidence included; a systematic review of various observational studies, RCTs (Randomized Controlled Studies), quantitative as well as qualitative studies. The recommendations provided in this guideline are made based on the supporting evidence offered under each section. As such, the recommendations are graded according to the NHMRC (National Health and Medical Research Council) recommendation grades and levels of evidence. Overall, formulation of the recommendations was made based on the experts’ opinions as well as clinical experience (Boddice et al., 2010). In relation to finding the suitable studies to be used on developing this guideline, a systematic selection of the suitable and relevant studies was carried out in 2009 (Between May and August). Among the key electronic databases utilized in the literature search included; EMBASE, CINAHL, Cochrane libraries and Medline. Additionally, the reference lists of the selected articles as well as other international guidelines such as those published by RCP (Royal College of Physicians), AHA (American Heart Association) and ESO (European Stroke Organization) were used in selecting further studies that were utilized in developing this guideline. Ultimately, experts in stroke were used in reviewing the selected studies and suggesting other studies. In regard to reviewing, the experts mainly utilized the abstracts as well as titles of the identified studies whereby any irrelevant studies were excluded from the development of this guideline. Subsequently, the reviewers evaluated and selected the most appropriate studies though the use a well-structured inclusion criteria. Among the key aspects that were used in selection of the eligible studies included; type of participants as well as study and the publication language whereby the studies included were those involving stroke patients aged above 18 years, RCTs or other level I or II evidence studies and those published only in English.
On the other hand, reviewing as well as updating of the draft document involved consultation and feedbacks from various experts including members of the NSF (National Stroke foundation) and subsequently a medical editor was used in the review of this guideline so as to ensure language consistency.
Clarity and presentation
The various recommendations offered in this CPG are definite and specific in regard to care as well as management types of stroke among individuals aged above eighteen years of age. Furthermore, the guidelines offers the various options that can be used in stroke care as well as management. For instance, the guideline offers the recommendations for hospital-care, surgical management, acute medical management as well as secondary prevention strategies that can be used to minimize hospital re-admissions among individuals suffering from stroke through effective management of the illness. Overall, the key recommendations involved in this guideline are highlighted to foster easy navigation and enable users to easily locate the appropriate and relevant recommendations to be utilized in specific clinical scenarios.
Editorial independence
The guideline has a clear and explicit statement that indicates that the interests and the views of the funding body have not in any manner influenced the development of this CPG, particularly in regard to the final recommendations included in this guideline. More importantly, the guideline has a clear and definite statement that indicates that the competing interests among the members of the development group were effectively addressed. In relation to this, all the members of the development group (i.e. the expert working group) signed a declaration form in regard to the conflicts of interests whereby most of them did not have perceived conflicts apart from a few who had received finances from various organizations for engaging in clinical research.
Applicability
The key goal of this guideline is to assists healthcare professionals in enhancing the effectiveness as well as the quality of care offered to stroke patients. However, the various recommendations involved in this guideline cannot be unanimously applied in all the clinical settings. In the light of this, the healthcare workers are advised to identify the potential facilitators as well as barriers to evidence-based care in their clinical settings so as to determine the most suitable and best strategies that can be used to foster optimal care of stroke patients within their individual clinical settings. In regard to the implications of using these recommendations, the major resource implications for using these recommendations in healthcare have been effectively addressed. For instance, the guideline emphasizes the need to offer particular resources such as transportation services, cultural safety as well as workforce development when dealing with individuals from the minority ethnic groups such as the aboriginals and those from the Maori heritage. In relation to the audit criteria, all healthcare services related to stroke should be included in the QIA (Quality Improvement Activities) through constant feedbacks and audits especially after two Years so as to foster best care practices in regard to stroke care as well as management.
In reference to the case scenario, this guideline offers appropriate and best evidence especially in regard to rehabilitation of stoke patients. Thus, the recommendations pertaining to rehabilitation shall assist me to effectively coordinate Mary’s care and develop a suitable care plan to adequately support her recovery and meet her ADLs (Activities of daily living). For example, the recommendations pertaining to ADL shall enable me to develop a suitable care plan to foster optimal recovery of the patient. More importantly, the guideline offers valuable information and recommendations in regard to the organization of care services involving patients from diverse cultural backgrounds. For instance, the guideline provides information on the key barriers that hinder equitable access to healthcare services especially among individuals from the minority ethnic groups such as the Maori (Mary’s ethnic group). As such, this information shall help me to organize the best care services that meets the patient’s unique needs so as to foster optimal recovery of the patient (Polit & Beck, 2013).
Conclusion
The “Clinical Guidelines for Stroke Management 2010” is an effective and appropriate guideline that provides a wide range of evidence-based intervention strategies and recommendations in relation to stroke care as well as management. As such, the adoption of these recommendations and their integration in to the delivery of care services to stroke patients by the healthcare professionals shall foster optimal care of stroke patients and minimize the variations witnessed especially in rehabilitation care thereby improving patients’ outcomes (Ransohoff, Pignone & Sox, 2013).
References
Boddice, G., Brauer, S., Gustafsson, L., Kenardy, J., & Hoffmann, T. (2010). Clinical Guidelines for Stroke Management 2010.
Brouwers, M. C., Kho, M. E., Browman, G. P., Burgers, J. S., Cluzeau, F., Feder, G., & Littlejohns, P. (2010). AGREE II: advancing guideline development, reporting and evaluation in health care. Canadian Medical Association Journal, 182(18), E839-E842.
Polit, D. F., & Beck, C. T. (2013). Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins.
Ransohoff, D. F., Pignone, M., & Sox, H. C. (2013). How to decide whether a clinical practice guideline is trustworthy. JAMA, 309(2), 139-140.
Rohde, A., Worrall, L., & Le Dorze, G. (2013). Systematic review of the quality of clinical guidelines for aphasia in stroke management. Journal of evaluation in clinical practice, 19(6), 994-1003.
Shekelle, P., Woolf, S., Grimshaw, J. M., Schünemann, H. J., & Eccles, M. P. (2012). Developing clinical practice guidelines: reviewing, reporting, and publishing guidelines; updating guidelines; and the emerging issues of enhancing guideline implementability and accounting for comorbid conditions in guideline development. Implementation Science, 7(1), 62.
