The Clinical Guidelines for Stroke Management – Part 1

By Simone Dorsch and Coralie English

Associate Professor Coralie English is a physiotherapist and a stroke clinical trialist. Her research focuses on understanding the health benefits of physical activity and sedentary behaviour for people after stroke, as well as optimal models of improving walking and arm function early after stroke.

This Blog is written in two parts.

• The Development of the new guidelines and What’s New
• Key messages of the new guidelines for Physio and OT

The new guidelines have been in development since July 2015. This has been a mammoth task. To give you an idea: it has involved 11 working parties of almost 100 healthcare professionals. They reviewed 109,620 abstracts, a 267% increase since the last guidelines. They had 89 clinical questions and around 300 PICO (Population, Intervention, Comparator and Outcome) questions. The results from around 800 studies were included in the final guidelines.

Associate Professor Coralie English from the University of Newcastle was Co-Chair of the Guidelines Content Development Working Group and co-ordinated the 16 physiotherapists who volunteered their time to assist in the development of the guidelines in the Physiotherapy Working Party. Coralie says the process was “exhausting but extremely rewarding. It was an honour to work with such a dedicated team of people from the volunteer working party members who gave generously of their time and expertise to the professionalism and dedication of the Project Team at the Stroke Foundation.”

What’s new in the 2017 update?

• Greater consumer focus: There were consumers on the Guidelines working party, and both the Stroke Foundation Consumer Council and stroke survivor groups reviewed and commented on the public release of the draft guidelines.
• Move to Living Guidelines: The Stroke Foundation is intending to maintain a Living Guideline meaning that updated recommendations will be reviewed and updated as new evidence is published.
• Change in the grading system: The grades of recommendation for interventions are now divided into three recommendations; strong, weak and practice statement.
  • STRONG recommendations exist where guideline authors are certain that the evidence is clear and unlikely to change
  • WEAK recommendations exist where the evidence is less strong and there is the potential for new evidence to change the recommendation in the future. It is important to note that a weak recommendation for an intervention means that while there is evidence for the effectiveness of the intervention, it is less robust than for strong recommendations. These interventions should still be used in practice. The Guidelines also importantly tell us what interventions should NOT be done based on either lack of evidence or evidence of no effect.

Transparency: There is a greater depth of detail about the evidence that has been used to inform the recommendations. This includes a summary of the rationale behind each recommendation, a statement on the quality of the evidence and a calculation of the absolute effect estimates for outcomes. There are also statements on the benefits and harms of interventions and on economic implications where relevant.