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The Future of INCOG (Is Now). J Head Trauma Rehabil 2023; 38:103-107. [PMID: 36594862 DOI: 10.1097/htr.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What's Changed From 2014 to Now? J Head Trauma Rehabil 2023; 38:1-6. [PMID: 36594855 DOI: 10.1097/htr.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: Methods, Overview, and Principles. J Head Trauma Rehabil 2023; 38:7-23. [PMID: 36594856 DOI: 10.1097/htr.0000000000000838] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Moderate to severe traumatic brain injury (TBI) results in complex cognitive sequelae. Despite hundreds of clinical trials in cognitive rehabilitation, the translation of these findings into clinical practice remains a challenge. Clinical practice guidelines are one solution. The objective of this initiative was to reconvene the international group of cognitive researchers and clinicians (known as INCOG) to develop INCOG 2.0: Guidelines for Cognitive Rehabilitation Following TBI. METHODS The guidelines adaptation and development cycle was used to update the recommendations and derive new ones. The team met virtually and reviewed the literature published since the original INCOG (2014) to update the recommendations and decision algorithms. The team then prioritized the recommendations for implementation and modified the audit tool accordingly to allow for the evaluation of adherence to best practices. RESULTS In total, the INCOG update contains 80 recommendations (25 level A, 15 level B, and 40 level C) of which 27 are new. Recommendations developed for posttraumatic amnesia, attention, memory, executive function and cognitive-communication are outlined in other articles, whereas this article focuses on the overarching principles of care for which there are 38 recommendations pertaining to: assessment (10 recommendations), principles of cognitive rehabilitation (6 recommendations), medications to enhance cognition (10 recommendations), teleassessment (5 recommendations), and telerehabilitation intervention (7 recommendations). One recommendation was supported by level A evidence, 7 by level B evidence, and all remaining recommendations were level C evidence. New to INCOG are recommendations for telehealth-delivered cognitive assessment and rehabilitation. Evidence-based clinical algorithms and audit tools for evaluating the state of current practice are also provided. CONCLUSIONS Evidence-based cognitive rehabilitation guided by these recommendations should be offered to individuals with TBI. Despite the advancements in TBI rehabilitation research, further high-quality studies are needed to better understand the role of cognitive rehabilitation in improving patient outcomes after TBI.
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Lumba-Brown A, Prager EM, Harmon N, McCrea MA, Bell MJ, Ghajar J, Pyne S, Cifu DX. A Review of Implementation Concepts and Strategies Surrounding Traumatic Brain Injury Clinical Care Guidelines. J Neurotrauma 2021; 38:3195-3203. [PMID: 34714147 DOI: 10.1089/neu.2021.0067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Despite considerable efforts to advance the science surrounding traumatic brain injury (TBI), formal efforts supporting the current and future implementation of scientific findings within clinical practice and healthcare policy are limited. While many and varied guidelines inform the clinical management of TBI across the spectrum, clinicians and healthcare systems are not broadly adopting, implementing, and/or adhering to them. As part of the Brain Trauma Blueprint TBI State of the Science, an expert workgroup was assembled to guide this review article, which describes: (1) possible etiologies of inadequate adoption and implementation; (2) enablers to successful implementation strategies; and (3) strategies to mitigate the barriers to adoption and implementation of future research.
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Affiliation(s)
- Angela Lumba-Brown
- Department of Emergency Medicine, Stanford University, Stanford, California, USA
| | | | | | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Neurosurgery Research Laboratory, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Michael J Bell
- Pediatrics, Critical Care Medicine, Children's National Hospital, Washington DC, USA
| | - Jamshid Ghajar
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Scott Pyne
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
| | - David X Cifu
- Virginia Commonwealth University School of Medicine, and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA
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Ullah S, Bin Ayaz S, Moukais IS, Qureshi AZ, Alumri T, Wani TA, Aldajani AA. Factors affecting functional outcomes of traumatic brain injury rehabilitation at a rehabilitation facility in Saudi Arabia. ACTA ACUST UNITED AC 2021; 25:169-175. [PMID: 32683395 PMCID: PMC8015482 DOI: 10.17712/nsj.2020.3.20190097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objectives: To identify the factors that affect disability after inpatient rehabilitation (IPR) in persons with traumatic brain injury (TBI). Methods: This retrospective study identified 140 patients aged ≥16 years who were admitted to the TBI rehabilitation unit at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia between 2015 and 2017. The collected data included demographic variables, TBI cause, coma duration, time from injury to IPR, LOS, and Functional Independence Measure (FIM) scores at IPR admission and discharge. Results: Majority of the patients were young males. The TBI was caused by motor vehicle accidents (MVA) in 95% of patients. The mean coma duration, time from injury to IPR admission, and LOS were 47±38, 264±357, and 75±52 days, respectively. The factors that were found to have an association with FIM change were time from injury to IPR admission (p=0.003, r=-0.250), admission FIM score (p=0.003, r=-0.253), and discharge FIM score (p<0.001, r=0.390). Employed patients had high FIM scores at admission (p=0.029, r=0.184) and discharge (p=0.003, r=0.252). Conclusion: Reduction in disability at discharge was positively associated with the severity of disability at admission and negatively with the time duration from injury to IPR admission, indicating a need to reduce time before admittance to an IPR setup. The high incidence of MVA causing TBI in a young male population strongly points to a need for appropriate measures of prevention.
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Affiliation(s)
- Sami Ullah
- Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail:
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Quality Appraisal of Systematic Reviews for Behavioral Treatments of Attention Disorders in Traumatic Brain Injury. J Head Trauma Rehabil 2020; 34:E42-E50. [PMID: 30499927 DOI: 10.1097/htr.0000000000000444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This review appraised the quality of systematic reviews (SRs) and meta-analyses (MAs) to summarize research on behavioral interventions for attention disorders in persons with traumatic brain injury. METHODS A search of 7 databases revealed 15 MAs/SRs reporting outcomes for attention treatments in traumatic brain injury. Two examiners independently coded the quality of reviews with the Critical Appraisal of Systematic Review or Meta-Analysis and the Evidence in Augmentative and Alternative Communication Systematic Review Scale. RESULTS The findings of both scales were highly correlated. Four reviews were conducted with high methodologic rigor indicated by a score of 60% or greater on both scales. No other study scored above 45%. Among the well-conducted SRs/MAs, evidence for direct attention training effects was limited to basic attention exercises, with little generalization to functional activities. Strategy training for activities and tasks requiring attentional abilities had a stronger evidence base in 1 rigorous MA. CONCLUSIONS This appraisal provides valuable practice information. The conclusions of 4 rigorous reviews suggest that there is only limited positive scientific support for the effects of attention treatments for traumatic brain injury. Future SRs/MAs would benefit from adherence to review guidelines.
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Unique Features of the INESSS-ONF Rehabilitation Guidelines for Moderate to Severe Traumatic Brain Injury: Responding to Users' Needs. J Head Trauma Rehabil 2019; 33:296-305. [PMID: 30188459 DOI: 10.1097/htr.0000000000000428] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) clinical practice guidelines are a potential solution to rapidly expanding literature. The project objective was to convene experts to develop a unique set of TBI rehabilitation recommendations incorporating users' priorities for format and implementation tools including indicators of adherence. METHODS The Guidelines Adaptation & Development Cycle informed recommendation development. Published TBI recommendations were identified and tabulated. Experts convened to adapt or, where appropriate, develop new evidence-based recommendations. These draft recommendations were validated by systematically reviewing relevant literature. Surveys of experts and target users were triangulated with strength of evidence to identify priority topics. RESULTS The final recommendation set included a rationale, implementation tools (algorithms/adherence indicators), key process indicators, and evidence summaries, and were divided in 2 sections: Section I: Components of the Optimal TBI Rehabilitation System (71 recommendations) and Section II: Assessment and Rehabilitation of Brain Injury Sequelae (195 recommendations). The recommendations address top priorities for the TBI rehabilitation system: (1) intensity/frequency of interventions; (2) rehabilitation models; (3) duration of interventions; and (4) continuity-of-care mechanisms. Key sequelae addressed (1) behavioral disorders; (2) cognitive dysfunction; (3) fatigue and sleep disturbances; and (4) mental health. CONCLUSION This TBI rehabilitation guideline used a robust development process to address users' priorities.
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A technical appraisal of guidelines for the management of skin rash in patients on chemotherapy and targeted therapy. BMC Health Serv Res 2019; 19:704. [PMID: 31619221 PMCID: PMC6794896 DOI: 10.1186/s12913-019-4539-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/16/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Skin rash remains one of the most prevalent and troublesome clinical problems experienced by patients on chemotherapy and targeted therapy. To ensure high-quality care, guidelines are seen as the best guidance. Considering the quality of guidelines varies greatly, a systematical appraisal of the methodological quality of guidelines for the management of skin rash in patients on chemotherapeutic drugs and targeted anticancer therapies was undertaken, in order to identify appropriate ones for healthcare professionals. METHODS A systematic search of databases and Internet was conducted to obtain pertinent guidelines. Two reviewers independently assessed the eligibility of guidelines according to the inclusion criteria. Then the guidelines included were appraised by three researchers with the methodological quality of eligible guideline using Appraisal of Guidelines for Research and Evaluation II (AGREEII). RESULTS Totally nineteen guidelines met the inclusion criteria. The quality ranged from good to acceptable in scope and purpose (mean: 78.80%, range: 66.67-94.44%) and clarity of presentation domains (mean: 85.38%, 75.00-91.67%), but not in stakeholder involvement (mean: 50.15%, range: 36.11-75.00%), rigor of development (mean: 23.65%, range: 6.25-70.83%), applicability (mean: 23.96%, range: 4.17-52.08%), and editorial independence domains (mean: 45.18%, range: 0.00-87.50%). Overall, two guidelines were classified as "recommended". CONCLUSIONS Only two guidelines were recommended to manage skin rash in patients on chemotherapy and targeted therapies, most guidelines issued were of low to moderate quality. Thus, more attention should be paid to the methodological quality of guideline development in this field.
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Bragge P, Guy S, Boulet M, Ghafoori E, Goodwin D, Wright B. A systematic review of the content and quality of clinical practice guidelines for management of the neurogenic bladder following spinal cord injury. Spinal Cord 2019; 57:540-549. [PMID: 30971756 DOI: 10.1038/s41393-019-0278-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Neurogenic bladder following acute spinal cord injury (SCI) increases urinary tract infection (UTI) risk and affects quality of life and health system costs. OBJECTIVES This study aimed to identify, describe and evaluate quality of clinical practice guidelines (CPGs) for managing neurogenic bladder following SCI. METHODS A comprehensive search covered six electronic databases (PubMed, Web of Science, Health Systems Evidence, Cochrane, CINAHL, Epistomonikos) and 12 CPG portals. Inclusion criteria were English language CPG; includes recommendations for managing neurogenic bladder in adults; all phases of care; published 2011 onwards in peer-reviewed journal/CPG portal. For eligible CPGs, key characteristics including years covered by CPG searching and number of neurogenic bladder recommendations were extracted. Quality appraisal used the AGREE II instrument. Appraiser agreement was assessed using the intraclass correlation coefficient. RESULTS Searching yielded 4028 citations and eight relevant CPGs. Collectively the CPGs contained 304 recommendations. Over half (160) pertained to assessment, surgery or education. Most surgery recommendations were from older CPGs; more recent CPGs emphasised conservative therapy. Methodological quality across CPGs was good in the domains of 'clarity of presentation' (84% mean domain score), 'scope and purpose' (72%) and 'editorial independence' (68%). There were shortcomings in the domains of 'rigor of development' (52%) 'stakeholder involvement' (42%) and 'applicability' (33%). CONCLUSION CPGs for the management of neurogenic bladder following SCI are generally robust in stating their scope and clearly presenting recommendations. Only three CPGs attained domain scores over 70% pertaining to methodological rigor. Future CPGs should also focus on providing implementation / audit resources and incorporating patient perspectives.
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Affiliation(s)
- Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Australia.
| | - Stacey Guy
- Lawson Health Research Institute, London, Ontario, Canada
| | - Mark Boulet
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Australia
| | | | - Denise Goodwin
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Australia
| | - Breanna Wright
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Australia
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A Systematic Critical Appraisal of Evidence-Based Clinical Practice Guidelines for the Rehabilitation of Children With Moderate or Severe Acquired Brain Injury. Arch Phys Med Rehabil 2019; 100:711-723. [DOI: 10.1016/j.apmr.2018.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/23/2018] [Accepted: 05/31/2018] [Indexed: 12/31/2022]
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Cognitive Rehabilitation Following Traumatic Brain Injury: A Survey of Current Practice in Australia. BRAIN IMPAIR 2018. [DOI: 10.1017/brimp.2018.12] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background and Objective: As cognitive impairments represent the greatest impediment to participation following moderate–severe traumatic brain injury (TBI), cognitive rehabilitation is vital. Several sets of guidelines for cognitive rehabilitation have been published, including INCOG in 2014. However, little is known about current practice by therapists working with individuals with TBI. This study aimed to characterise current cognitive rehabilitation practices via an online survey of therapists engaged in rehabilitation in individuals with TBI.Method: The survey documented demographic information, current cognitive rehabilitation practice, resources used to inform cognitive rehabilitation, and reflections on cognitive rehabilitation provided.Results: The 221 Australian respondents were predominantly occupational therapists, neuropsychologists, and speech pathologists with an average 9 years of clinical experience in cognitive rehabilitation and TBI. Cognitive retraining and compensatory strategies were the most commonly identified approaches used in cognitive rehabilitation. Executive functioning was mostly targeted for retraining, whereas memory was targeted with compensatory strategies. Attentional problems were less frequently addressed. Client self-awareness, family involvement, team collaboration, and goal-setting were seen as important ingredients for success.Conclusion: Clinical practice of cognitive rehabilitation in Australia is broadly consistent with guidelines. However, addressing the impediments to its delivery is important to enhance the quality of life for individuals with TBI.
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Wellmann R, Borden BA, Danahey K, Nanda R, Polite BN, Stadler WM, Ratain MJ, O'Donnell PH. Analyzing the clinical actionability of germline pharmacogenomic findings in oncology. Cancer 2018; 124:3052-3065. [PMID: 29742281 DOI: 10.1002/cncr.31382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Germline and tumor pharmacogenomics impact drug responses, but germline markers less commonly guide oncology prescribing. The authors hypothesized that a critical number of clinically actionable germline pharmacogenomic associations exist, representing clinical implementation opportunities. METHODS In total, 125 oncology drugs were analyzed for positive germline pharmacogenomic associations in journals with impact factors ≥5. Studies were assessed for design and genotyping quality, clinically relevant outcomes, statistical rigor, and evidence of drug-gene effects. Associations from studies of high methodologic quality were deemed potentially clinically actionable, and translational summaries were written as point-of-care clinical decision support (CDS) tools and formally evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. RESULTS The authors identified germline pharmacogenomic results for 56 of 125 oncology drugs (45%) across 173 publications. Actionable associations were detected for 12 drugs, including 6 that had germline pharmacogenomic information within US Food and Drug Administration labels or published guidelines (capecitabine/fluorouracil/dihydropyrimidine dehydrogenase [DPYD], irinotecan/uridine diphosphate glucuronosyltransferase family 1 member A1 [UGT1A1], mercaptopurine/thioguanine/thiopurine S-methyltransferase [TPMT], tamoxifen/cytochrome P450 [CYP] family 2 subfamily D member 6 [CYP2D6]), and 6 others were novel (asparaginase/nuclear factor of activated T-cells 2 [NFATC2]/human leukocyte antigen D-related β1 [HLA-DRB1], cisplatin/acylphosphatase 2 [ACYP2], doxorubicin/adenosine triphosphate-binding cassette subfamily C member 2/Rac family small guanosine triphosphatase 2/neutrophil cytosolic factor 4 [ABCC2/RAC2/NCF4], lapatinib/human leukocyte antigen DQ α1 [HLA-DQA1], sunitinib/cytochrome P450 family 3 subfamily A member 5 [CYP3A5], vincristine/centrosomal protein 72 [CEP72]). By using AGREE II, the developed CDS summaries had high mean ± standard deviation scores (maximum score, 100) for scope and purpose (92.7 ± 5.1) and rigour of development (87.6 ± 7.4) and moderate yet robust scores for clarity of presentation (58.6 ± 25.1) and applicability (55.9 ± 24.6). The overall mean guideline quality score was 5.2 ± 1.0 (maximum score, 7). Germline pharmacogenomic CDS summaries for these 12 drugs were recommended for implementation. CONCLUSIONS Several oncology drugs have actionable germline pharmacogenomic information, justifying their delivery through institutional pharmacogenomic implementations to determine clinical utility. Cancer 2018;124:3052-65. © 2018 American Cancer Society.
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Affiliation(s)
- Rebecca Wellmann
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Brittany A Borden
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois
| | - Keith Danahey
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois.,Center for Research Informatics, The University of Chicago, Chicago, Illinois
| | - Rita Nanda
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois.,Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Blase N Polite
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois.,Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Walter M Stadler
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois.,Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Mark J Ratain
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois.,Department of Medicine, The University of Chicago, Chicago, Illinois.,Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, Illinois
| | - Peter H O'Donnell
- Center for Personalized Therapeutics, The University of Chicago, Chicago, Illinois.,Department of Medicine, The University of Chicago, Chicago, Illinois.,Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, Illinois
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Hoffmann-Eßer W, Siering U, Neugebauer EA, Lampert U, Eikermann M. Systematic review of current guideline appraisals performed with the Appraisal of Guidelines for Research & Evaluation II instrument—a third of AGREE II users apply a cut-off for guideline quality. J Clin Epidemiol 2018; 95:120-127. [DOI: 10.1016/j.jclinepi.2017.12.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/29/2017] [Accepted: 12/20/2017] [Indexed: 12/20/2022]
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Hoffmann-Eßer W, Siering U, Neugebauer EAM, Brockhaus AC, McGauran N, Eikermann M. Guideline appraisal with AGREE II: online survey of the potential influence of AGREE II items on overall assessment of guideline quality and recommendation for use. BMC Health Serv Res 2018; 18:143. [PMID: 29482555 PMCID: PMC5828401 DOI: 10.1186/s12913-018-2954-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 02/21/2018] [Indexed: 11/17/2022] Open
Abstract
Background The AGREE II instrument is the most commonly used guideline appraisal tool. It includes 23 appraisal criteria (items) organized within six domains. AGREE II also includes two overall assessments (overall guideline quality, recommendation for use). Our aim was to investigate how strongly the 23 AGREE II items influence the two overall assessments. Methods An online survey of authors of publications on guideline appraisals with AGREE II and guideline users from a German scientific network was conducted between 10th February 2015 and 30th March 2015. Participants were asked to rate the influence of the AGREE II items on a Likert scale (0 = no influence to 5 = very strong influence). The frequencies of responses and their dispersion were presented descriptively. Results Fifty-eight of the 376 persons contacted (15.4%) participated in the survey and the data of the 51 respondents with prior knowledge of AGREE II were analysed. Items 7–12 of Domain 3 (rigour of development) and both items of Domain 6 (editorial independence) had the strongest influence on the two overall assessments. In addition, Items 15–17 (clarity of presentation) had a strong influence on the recommendation for use. Great variations were shown for the other items. The main limitation of the survey is the low response rate. Conclusions In guideline appraisals using AGREE II, items representing rigour of guideline development and editorial independence seem to have the strongest influence on the two overall assessments. In order to ensure a transparent approach to reaching the overall assessments, we suggest the inclusion of a recommendation in the AGREE II user manual on how to consider item and domain scores. For instance, the manual could include an a-priori weighting of those items and domains that should have the strongest influence on the two overall assessments. The relevance of these assessments within AGREE II could thereby be further specified. Electronic supplementary material The online version of this article (10.1186/s12913-018-2954-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wiebke Hoffmann-Eßer
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670, Cologne, Germany. .,Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Campus Cologne, Cologne, Germany.
| | - Ulrich Siering
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670, Cologne, Germany
| | - Edmund A M Neugebauer
- Senior Professor for Health Services Research, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Anne Catharina Brockhaus
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670, Cologne, Germany
| | - Natalie McGauran
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670, Cologne, Germany
| | - Michaela Eikermann
- Medical Advisory Service of the German Social Health Insurance (MDS), Theodor-Althoff-Straße 47, 45133, Essen, Germany
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Martin S, Armstrong E, Thomson E, Vargiu E, Solà M, Dauwalder S, Miralles F, Daly Lynn J. A qualitative study adopting a user-centered approach to design and validate a brain computer interface for cognitive rehabilitation for people with brain injury. Assist Technol 2017; 30:233-241. [PMID: 28708963 DOI: 10.1080/10400435.2017.1317675] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Cognitive rehabilitation is established as a core intervention within rehabilitation programs following a traumatic brain injury (TBI). Digitally enabled assistive technologies offer opportunities for clinicians to increase remote access to rehabilitation supporting transition into home. Brain Computer Interface (BCI) systems can harness the residual abilities of individuals with limited function to gain control over computers through their brain waves. This paper presents an online cognitive rehabilitation application developed with therapists, to work remotely with people who have TBI, who will use BCI at home to engage in the therapy. A qualitative research study was completed with people who are community dwellers post brain injury (end users), and a cohort of therapists involved in cognitive rehabilitation. A user-centered approach over three phases in the development, design and feasibility testing of this cognitive rehabilitation application included two tasks (Find-a-Category and a Memory Card task). The therapist could remotely prescribe activity with different levels of difficulty. The service user had a home interface which would present the therapy activities. This novel work was achieved by an international consortium of academics, business partners and service users.
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Affiliation(s)
- Suzanne Martin
- a Faculty of life and Health Sciences , Ulster University , Jordanstown , Northern Ireland , UK
| | | | | | | | - Marc Solà
- c eHealth Department , EURECAT , Barcelona , Spain
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Hoffmann-Eßer W, Siering U, Neugebauer EAM, Brockhaus AC, Lampert U, Eikermann M. Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments. PLoS One 2017; 12:e0174831. [PMID: 28358870 PMCID: PMC5373625 DOI: 10.1371/journal.pone.0174831] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/15/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument is the most commonly used guideline appraisal tool. It includes 23 appraisal criteria (items) organized within 6 domains and 2 overall assessments (1. overall guideline quality; 2. recommendation for use). The aim of this systematic review was twofold. Firstly, to investigate how often AGREE II users conduct the 2 overall assessments. Secondly, to investigate the influence of the 6 domain scores on each of the 2 overall assessments. MATERIALS AND METHODS A systematic bibliographic search was conducted for publications reporting guideline appraisals with AGREE II. The impact of the 6 domain scores on the overall assessment of guideline quality was examined using a multiple linear regression model. Their impact on the recommendation for use (possible answers: "yes", "yes, with modifications", "no") was examined using a multinomial regression model. RESULTS 118 relevant publications including 1453 guidelines were identified. 77.1% of the publications reported results for at least one overall assessment, but only 32.2% reported results for both overall assessments. The results of the regression analyses showed a statistically significant influence of all domains on overall guideline quality, with Domain 3 (rigour of development) having the strongest influence. For the recommendation for use, the results showed a significant influence of Domains 3 to 5 ("yes" vs. "no") and Domains 3 and 5 ("yes, with modifications" vs. "no"). CONCLUSIONS The 2 overall assessments of AGREE II are underreported by guideline assessors. Domains 3 and 5 have the strongest influence on the results of the 2 overall assessments, while the other domains have a varying influence. Within a normative approach, our findings could be used as guidance for weighting individual domains in AGREE II to make the overall assessments more objective. Alternatively, a stronger content analysis of the individual domains could clarify their importance in terms of guideline quality. Moreover, AGREE II should require users to transparently present how they conducted the assessments.
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Affiliation(s)
- Wiebke Hoffmann-Eßer
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Campus Cologne, Cologne, Germany
| | - Ulrich Siering
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Edmund A. M. Neugebauer
- Brandenburg Medical School – Theodor Fontane Neuruppin, Germany & University of Witten/Herdecke, Witten/Herdecke, Germany
| | | | - Ulrike Lampert
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Michaela Eikermann
- Medical Advisory Service of the German Social Health Insurance (MDS), Essen, Germany
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Management of Spasticity in Moderate and Severe Traumatic Brain Injury: Evaluation of Clinical Practice Guidelines. J Head Trauma Rehabil 2017; 32:E1-E12. [DOI: 10.1097/htr.0000000000000234] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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De Luca R, Calabrò RS, Bramanti P. Cognitive rehabilitation after severe acquired brain injury: current evidence and future directions. Neuropsychol Rehabil 2016; 28:879-898. [DOI: 10.1080/09602011.2016.1211937] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Rosaria De Luca
- Behavioral and NeuroRobotic Rehabilitation Laboratory, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Rocco Salvatore Calabrò
- Behavioral and NeuroRobotic Rehabilitation Laboratory, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Placido Bramanti
- Behavioral and NeuroRobotic Rehabilitation Laboratory, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
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INCOG recommendations for management of cognition following traumatic brain injury, part IV: cognitive communication. J Head Trauma Rehabil 2015; 29:353-68. [PMID: 24984097 DOI: 10.1097/htr.0000000000000071] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cognitive-communication disorders are common in individuals with traumatic brain injury (TBI) and can have a major impact on long-term outcome. Guidelines for evidence-informed rehabilitation are needed, thus an international group of researchers and clinicians (known as INCOG) convened to develop recommendations for assessment and intervention. METHODS An expert panel met to select appropriate recommendations for assessment and treatment of cognitive-communication disorders based on available literature. To promote implementation, the team developed decision algorithms incorporating the recommendations, based on inclusion and exclusion criteria of published trials, and then prioritized recommendations for implementation and developed audit criteria to evaluate adherence to best practice recommendations. RESULTS Rehabilitation of individuals with cognitive-communication disorders should consider premorbid communication status; be individualized to the person's needs, goals, and skills; provide training in use of assistive technology where appropriate; include training of communication partners; and occur in context to minimize the need for generalization. Evidence supports treatment of social communication problems in a group format. CONCLUSION There is strong evidence for person-centered treatment of cognitive-communication disorders and use of instructional strategies such as errorless learning, metacognitive strategy training, and group treatment. Future studies should include tests of alternative service delivery models and development of participation-level outcome measures.
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Ponsford J, Janzen S, McIntyre A, Bayley M, Velikonja D, Tate R. INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part I. J Head Trauma Rehabil 2014; 29:307-20. [DOI: 10.1097/htr.0000000000000074] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part III. J Head Trauma Rehabil 2014; 29:338-52. [DOI: 10.1097/htr.0000000000000068] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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INCOG Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury. J Head Trauma Rehabil 2014; 29:290-306. [DOI: 10.1097/htr.0000000000000070] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part II. J Head Trauma Rehabil 2014; 29:321-37. [DOI: 10.1097/htr.0000000000000072] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part V. J Head Trauma Rehabil 2014; 29:369-86. [DOI: 10.1097/htr.0000000000000069] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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