Review of clinical practice guidelines relating to cognitive assessment in stroke

Abstract

Purpose: To assess the content, quality, and supporting evidence base of clinical practice guidelines (CPGs) with reference to cognitive assessment in stroke. Materials and methods: We performed a systematic review to identify eligible CPGs pertaining to cognitive assessment in adult stroke survivors. We compared content and strength of recommendations. We used the AGREE-II (appraisal of guidelines for research and evaluation) tool to appraise the quality of the guideline. Results: Eight eligible guidelines were identified and seven were rated as high quality (i.e., appropriately addressing at least four domains of the AGREE-II tool including “rigor of development”). There was heterogeneity in the recommendations offered and limited guidance on fundamental topics such as which cognitive test to use or when to perform testing. Generally, the lowest quality of evidence (expert opinion) was used to inform these recommendations. Conclusions: Although assessment of cognition is a key aspect of stroke care, there is a lack of guidance for clinicians. The limited evidence base, in part, reflects the limited research in the area. A prescriptive approach to cognitive assessment may not be suitable, but more primary research may help inform practice.Implications for rehabilitation Cognitive assessment in stroke exhibits substantial variation in practice, clinical practice guidelines rarely give prescriptive recommendations on which approach to take. Where guideline recommendations on cognitive assessment in stroke were made these were based on expert opinion. Our summary of the guideline content found certain areas of consensus, for example, routine assessment using validated tools.