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

National clinical guideline for stroke
any other relevant consensus statements or recommendations and also evidence from
qualitative studies which were often powerful and informative.
It is important to note that the evidence relating to specific individual interventions,
usually drugs, is generally stronger, because it is methodologically easier to study them in
contrast to investigating multifaceted interventions over longer periods of time. This does
not necessarily mean that interventions with so-called strong evidence are more
important than those where the evidence is weak.
1.6.6 Strength of recommendation
Traditionally, recommendations have been given a strength which derived entirely from
the design of the studies providing evidence. This system has several flaws. Strong
evidence for less important recommendations gives them an apparent higher priority
than a vital recommendation where the evidence is weaker. The strength depends solely
upon study design and ignores other important features of the evidence such as its
plausibility, selection bias, and sample size. It fails to give readers guidance on what is
important; it only gives information on evidence, and even that is limited information.
For this guideline, an alternative approach was taken.
Once all the recommendations were finalised, a formal consensus approach was used to
identify the key recommendations, these are listed in the key recommendations section.
1.6.7 Peer review
Following review of the literature and initial agreement of the guideline by the working
party, there was a period of peer review during which experts in all disciplines both from
the UK and internationally, including patients’ organisations, were asked to review the
guideline. Changes were made to the guideline accordingly. Thanks are due to the
reviewers (listed in appendix 2) who took so much time and trouble to give the benefit of
their knowledge and expertise.
1.7 Models underlying guideline development
The guideline has used several models or frameworks to structure its work and layout. In
summary these were:
> the Donabedian model (Donabedian 1978) for considering healthcare: structure,
process and outcome
> the healthcare process: diagnosis/assessment, goal setting, intervention (treatment and
support), and re-evaluation
> the WHO’s international classification of functioning, disability and health (WHO
ICF) model (Wade and Halligan 2004; World Health Organization 2001)
> time: prevention, acute, subacute (recovery) and long-term.
1.7.1 Patient interactions – World Health Organization
The document uses the WHO ICF model (see table 1.1) especially as a basis for
recommendations that relate to direct patient interactions. Thus we consider:
8 © Royal College of Physicians 2012