Review of clinical practice guidelines relating to cognitive assessment in stroke

Figures & data

Figure 1. PRISMA flow diagram.

Table 1. PICAR inclusion criteria for the review.

PICAR element	Study specific criteria
Population, clinical area, and characteristics	Adults (>18 years old) with history of stroke, regardless of pre-existing cognitive status.
	Assessment could be performed in any clinical setting.
	Clinical practice guidelines will be categorised by setting and timing on the stroke pathway, defined as: Hyper-acute stroke (first 48 h) Acute stroke (first month) Rehabilitation Outpatient Community
Interventions	A global cognitive assessment strategy including screening tools and tools for assessment of delirium (but not including single domain specific tools designed for a specific purpose, i.e., aphasia tools).
Comparators	No direct comparators.
Attributes of CPGs	Language: English language or has English language version.
	Publication regions: Any.
	Version: Only the latest versions of CPGs are to be included.
	Age: From 2008 to 2021 inclusive ensuring only up to date practice is captured.
	Development strategies: Evidence-based medicine approach with synthesis of published literature and other information sources and explicit evaluation of the quality of the supporting data.
	Rating of evidence: Employs a systemic way of evaluating the given evidence for recommendations.
	Scope: CPGs assessing cognition in adult patients with stroke disease.
	Recommendations: Reports on ≥1 recommendations of interest.
Recommendation characteristics	Interventions: Recommendations must explicitly discuss ≥1 assessment of interest.
	Comparators: Recommendations do not require to compare against cognitive testing in other groups, i.e., non-stoke patients.
	Confidence level: Must describe how bias has been assessed and reduced where possible.
	Clinical considerations of interest How to assess: Which cognitive assessment to use. When to assess: Assessed by timing and setting. Who should assess: Which professionals should undertake these assessments and what training is required. How to use assessments: How should cognitive assessment inform care pathways and how should they be communicated to patients and families.

Table 2. Data extraction table of clinical practice guidelines.

Characteristics of CPGs	RCP’16	SIGN 118	SIGN 119	NICE 162	IHF’10	ASF’17	CHS’19	AHA’16
Adults >18 years old presenting with stroke	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Hyper-acute stroke (first 48 h)	No	Yes	Yes	No	Yes	Yes	Yes	Yes
Acute stroke (first month)	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes
Rehabilitation of stroke	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Outpatient stroke	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes
Community stroke	No	Yes	No	No	Yes	Yes	Yes	Yes
A cognitive screening instrument	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
English language only in the first instance	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Where CPG published	UK	Scotland	Scotland	England and Wales	ROI	Australia	Canada	USA
Only the latest version of CPGs	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
2008–2019 inclusive	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Explicitly describes cognition or delirium testing	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Transparent method of evidence synthesis	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Systematic rating of the evidence	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Utilises only evidence-based medicine (EBM) where evidence is transparently appraised	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Assess all regardless of pre-existing cognitive status	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Comment on optimal assessment mode	Yes	No	No	No	No	No	Yes	Yes
Which professional is best placed to perform the assessment	No	Yes	No	No	No	Yes	Yes	No
Timing of assessment	No	No	No	No	No	No	No	No
How to use the assessment data	No	No	No	No	No	No	No	No

Royal College of Physicians Stroke 2016 (RCP’16); SIGN 118 stroke: June 2010 (SIGN 118); SIGN 119- Dysphasia June 2010 (SIGN 119); NICE 162: Stroke June 2013 (NICE 162); Irish Heart Foundation 2010 (IHF’10); Australian Stroke Foundation 2017 (ASF’17); Canadian Heart & Stroke 2019 (CHS’19); American Heart & Stroke Association 2016 (AHA’16).

Figure 2. AGREE-II score of stroke clinical practice guidelines.

Table 3. Stroke CPG recommendations and strength of evidence.