Systematic development of practice guidelines for psychological interventions in stroke rehabilitation

Abstract

Purpose: We aimed to develop evidence-based practice guidelines that can support decision-making in individual cases and be used by a multidisciplinary team in stroke rehabilitation.

Materials and methods: We conducted a literature search (step 1), and a survey of all neurological rehabilitation facilities in Germany concerning their structural working conditions and current practices (step 2). Based on this information, we drafted a first version of the practice guidelines, and discussed them with a group of experts (step 3). We also consulted concurrently with senior psychologists, head physicians (step 4), and patients after stroke (step 5). We revised the guidelines until consensus on the final version was reached (step 6).

Results: Referring to the ICF for guidance, the practice guidelines comprise of psychological recommendations in five problem areas (“Participation – Major Aims of Rehabilitation”, “Cognition”, “Affect & Behavior”, “Risk Factors”, and “Specific Problems & Aspects”), and provide preliminary remarks on general frame conditions and procedural requirements. The practice guidelines were widely accepted by head psychologists and physicians of in- and outpatient neurological rehabilitation with an average agreement of 97% (range: 88–100%).

Conclusions: Our practice guidelines include detailed recommendations for psychological interventions that can guide individual decision-making by a multidisciplinary team. Specific aspects to foster implementation were considered, and attempts were made to promote their dissemination.

Implications for Rehabilitation

• We developed practice guidelines for psychological interventions in rehabilitation after stroke based on the best available evidence.

• The practice guidelines include detailed recommendations for psychological interventions that can guide individual decisions by a multidisciplinary team.

• The practice guidelines are highly specific, and have been widely agreed upon by a group of experts from different professions as well as by researchers, patients, and clinicians (average agreement: 97%).

• The practice guidelines offer knowledge on different areas of psychological impairment, can help guide diagnostic and therapeutic procedures for individual patients, and thus, improve standard care in neurological rehabilitation.

Keywords:

• Neuropsychology
• psychological interventions
• practice guidelines
• rehabilitation
• stroke

Ethical Approval

The Ethics Committee of the University of Freiburg decided that there was no need for an explicit ethics committee approval.

Acknowledgements

We’d like to express our sincere gratitude to all experts who supported us.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the German Statutory Pension Insurance (Deutsche Rentenversicherung Bund) under Grant 0423/00–40-64–50-18.