Quality of stroke rehabilitation clinical practice guidelines
Bibliographic record
Abstract
BACKGROUND AND PURPOSE: Clinical practice guidelines (CPGs) are systematically developed statements that assist practitioners to provide appropriate evidence-based care. The purpose of this study was to evaluate the quality of currently published CPGs for stroke care and to examine the reliability and validity of the appraisal of guidelines, research and evaluation (AGREE) instrument. METHODS: Multiple databases and Internet resources were searched for stroke care CPGs. Guidelines included were published in English or French from 1998 to 2004 and developed by a group process. Four appraisers evaluated each CPG using the AGREE instrument. The AGREE consists of 23 items, ranked on a 4-point Likert scale, that is organized into six domains. A standardized score is calculated separately for each domain and ranges from 0 to 100. RESULTS: Eight guidelines were identified. The AGREE quality scores were high for the 'scope and purpose' domain (mean +/- SE = 71.2 +/- 5.48, intra-class correlation (ICC) = 0.66), and 'clarity and presentation' (mean +/- SE = 70.6 +/- 4.43, ICC = 0.66). There was wide variation in ratings of 'rigour of development' (mean +/- SE = 60.7 +/- 7.1, ICC = 0.75) and 'stakeholder involvement' (mean +/- SE = 52.6 +/- 7.14, ICC = 0.89). The 'editorial independence' (mean +/- SE = 38.1 +/- 8.72, ICC = 0.88) and 'applicability' (mean +/- SE = 35.1 +/- 4.93, ICC = 0.75) had the lowest scores. CONCLUSIONS: There is considerable variability in quality of stroke care guidelines but stroke guidelines score higher on the AGREE rigour of development domain than CPGs from other medical fields. The Scottish Intercollegiate Guideline Network, Veterans Affairs/Department of Defence, Royal College of Physicians, and the New Zealand Guidelines Group consistently scored the highest across the domains. Stroke rehabilitation clinicians should consider these results in selecting a guideline. CPG development groups can improve their AGREE scores by considering the cost of implementing their CPGs, pilot testing their CPGs, recording conflict of interest of development panel members and providing tools supporting application of their CPGs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.137 | 0.457 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.016 | 0.016 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.007 | 0.003 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".