The development of a clinical practice stroke guideline for physiotherapists in The Netherlands: A systematic review of available evidence |
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| Authors: | R. P. S. Van Peppen H. J. M. Hendriks N. L. U. Van Meeteren P. J. M. Helders G. Kwakkel |
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| Affiliation: | 1. Department of Physiotherapy-Research, Academy of Health Sciences, University Medical Center, Utrecht;2. Master of Science Programme in Physiotherapy-Research, Utrecht University, Utrecht;3. Department of Physiotherapy, Institute for Human Movement Studies, University for Professional Education, Utrechtr.vanpeppen@umcutrecht.nl;5. Department of Epidemiology, Maastricht University, Maastricht;6. Section Rehabilitation, Department Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht;7. Chair of Physiotherapy, Utrecht University and University Medical Center, Utrecht;8. Section Rehabilitation, Department Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht;9. Department of Physical Therapy, VU University Medical Center, Amsterdam, The Netherlands |
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| Abstract: | Purpose.?To develop a clinical practice guideline for the physiotherapy management of patients with stroke as support for the clinical decision-making process, especially with respect to the selection of appropriate interventions, prognostic factors and outcome measures.Introduction.?Physiotherapists have a high caseload of patients with stroke, so there is a need to identify effective evidence-based physiotherapy procedures. The availability of a guideline that includes information about prognostic factors, interventions, and outcome measures would facilitate clinical decision-making.Method.?A systematic computerized literature search was performed to identify evidence concerning the use of: (i) prognostic factors related to functional recovery; (ii) physiotherapy interventions in patients with stroke; and (iii) outcome measures to assess patients' progress in functional health. Experts, physiotherapists working in the field of stroke rehabilitation, and a multidisciplinary group of health professionals reviewed the clinical applicability and feasibility of the recommendations for clinical practice and their comments were used to compose the definitive guideline.Results.?Of 9482 relevant articles, 322 were selected. These were screened for methodological quality. Seventy-two recommendations for clinical practice were retrieved from these articles and included in the guideline: Six recommendations concerned the prediction of functional recovery of activities of daily living (ADL), including walking ability and hand/arm use; 65 recommendations concerned the choice of physiotherapy interventions; and 1 recommendation concerned the choice of outcome instrument to use. A core set of seven reliable, responsive, and valid outcome measures was established, to determine impairments and activity limitations in patients with stroke.Conclusions.?The guideline provides physiotherapists with an evidence-based instrument to assist them in their clinical decision making regarding patients with stroke. As most of the recommendations included in the guideline came from studies of patients in the post acute and chronic phase of stroke, and in general involved patients with less severe and uncomplicated stroke, more needs to be learned about the more complex cases. |
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| Keywords: | Clinical practice guideline physiotherapy rehabilitation stroke prognostic factors interventions outcome measures |
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