national-clinical-guidelines-for-stroke-fourth-edition

Appraisal (HTA) reports were used, and members of the working party brought their
own expertise and information from their organisations and professional bodies. For
topics newly added since 2008 searches included the time period from 1966 onwards; for
the remainder of the topics searches were performed from 2007 until February 2012.
Some papers in press beyond this date have also been included.
If a Cochrane systematic review and meta-analysis relevant to a topic has been published
within the last 1–2 years, further searches were not undertaken and the constituent
papers within were not individually reviewed. If there was substantial strong evidence
available, additional new small trials were generally not reviewed. From the initial
searches, a total of almost 1,600 papers were considered relevant for inclusion; out of
these, 607 were then reviewed.
1.6.3 Selection of articles for inclusion
Evidence was obtained from published material using the following principles:
Where sufficient evidence specifically relating to stroke was available, this alone was used.
In areas where limited research specific to stroke was available, then studies including
patients with other appropriate, usually neurological, diseases were used.
Evidence from uncontrolled studies was only used when there was limited or no evidence
from randomised controlled trials (RCTs). In general, evidence from single-case studies
was not used, primarily because it is usually difficult to draw general conclusions from
them. In addition, some evidence from qualitative studies has been included.
1.6.4 Assessing the quality of research
The nature and strength of the evidence behind each recommendation is summarised;
the actual evidence itself is in tables that are available on the RCP website. This statement
is brief, but should justify the recommendation and explain the link. We used:
> the van Tulder quality assessment system to assess quality of RCTs (van Tulder et al
1997)
> the checklist that was developed for the third edition of the guideline based on and
the widely used QUOROM checklist systematic reviews (Moher et al 1999)
> the RATS qualitative checklist for qualitative research (Clark 2003).
All studies that were likely to result in the development of a recommendation were
assessed by a second reviewer to ensure consistency and to reduce inter-rater variability.
1.6.5 From evidence to recommendation
1 Introduction
Published evidence rarely gives answers that can be translated directly into clinical
practice or into recommendations; interpretation is essential, taking the contextual
factors into account. The ‘evidence to recommendation’ sections explain the reasoning
underlying a decision on whether to make a recommendation or not, particularly for
contentious areas.
In the many areas of important clinical practice where evidence was not available, we
made consensus recommendations based on our collective views, but also drawing on
© Royal College of Physicians 2012 7