Applying Clinical Practice Guidelines to the Complex Patient: Insights for Practice and Policy from Stroke Rehabilitation
Bibliographic record
Abstract
In Canada, policy makers are working to align services with the Stroke Rehabilitation Best Practice Recommendations (SRBPR).Complicating the application of clinical practice guidelines (CPGs) is the fact that most strokes occur in the context of other diagnoses.We sought to understand clinicians' use of the CPGs and ascertain how much guidance regarding multimorbidity was available in the SRBPR.Study results indicated that using the recommendations was problematic due to a perceived lack of guidance regarding comorbidities and multimorbidity, and concerns regarding the applicability to "real-life patients."Comorbidities were mentioned in less than half of the recommendations, but no explicit guidance was provided regarding the management of comorbidities.Given the prevalence of multimorbidity in stroke rehabilitation, this clinical context is ideal for development and testing of CPGs that account for multimorbidity and other complexity factors.Results may also suggest limitations to using CPGs in the development of activitybased funding models.Provides explicit guidance for multimorbidity Alludes to holistic approach 5.1 Initial Stroke Rehabilitation Assessment No No No Eligibility and Admission Criteria for Stroke Rehabilitation Yes No No 5.2 Stroke Rehabilitation Unit Care No No Yes 5.3 Delivery of Inpatient Stroke Rehabilitation No No No 5.4 Outpatient and Community-Based Stroke Rehabilitation (Including ESD) No No No 5.5.1 Management of the Arm and Hand Following Stroke No No No 5.5.2Range of Motion and Spasticity in the Shoulder, Arm and Hand No No No 5.5.3Management of Shoulder Pain Following Stroke No No No 5.6.1 Lower Limb Mobility and Transfer Skills No No No 5.6.2Lower limb Spasticity Following Stroke No No No 5.6.3Lower Limb Gait Training Following Stroke Yes No No 5.6.4Falls Prevention Management Yes No No 5.7 Assessment and Management of Dysphagia and Malnutrition Following Stroke Yes No No 5.8 Rehabilitation of Visual Perceptual Deficits No No No 5.9 Rehabilitation to Improve Central Pain No No Yes 5.10 Rehabilitation to Improve Communication No No No 5.11 Life Roles and Activities No No No 6.1 Supporting Patients, Families And Informal Caregivers Following Stroke No No Yes 6.2 Patient, Family and Informal Caregiver Education Yes No Yes 6.3 Interprofessional Communication No No Yes 6.4 Discharge Planning No No Yes 6.5 Community Reintegration following Stroke Yes No Yes 6.6 Transition of Patients to Long-Term Care following a Stroke No No Yes 6.7 Post-Stroke Fatigue
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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 | 0.083 | 0.259 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.007 |
| Science and technology studies | 0.008 | 0.009 |
| Scholarly communication | 0.014 | 0.007 |
| Open science | 0.004 | 0.007 |
| Research integrity | 0.009 | 0.009 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
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".