Clinical practice guidelines for the management of brain tumours: A rehabilitation perspective
Woo-Jin Kim, Klara Novotna, Bhasker Amatya, Fary Khan
Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, 1485 Busan, South Korea. E-MAIL: firstname.lastname@example.org
Objective: To critically appraise published clinical practice guidelines (CPGs) for brain tumours, and to synthesize evidence-based recommendations from a rehabilitation perspective.
Methods: A comprehensive literature search included: health science databases, CPG clearinghouse/developer websites, and grey literature up to March 2018. All brain tumour CPGs that reported systematic methods for evidence search, and clearly defined recommendations supporting evidence for rehabilitation interventions were included. Three authors independently selected potential CPGs and assessed their methodological quality using the Appraisal of Guidelines, Research and Evaluation (AGREE-II) Instrument. Recommendations from included CPGs were categorized from a rehabilitation perspective.
Results: Of the 11 CPGs identified, only 2, developed by the National Institute for Health and Clinical Excellence (NICE) and the Australian Cancer Network (ACN), included rehabilitation components for the management of brain tumours. Both CPGs were of moderate quality. The recommendations reported were generic, and only the ACN guidelines provided detailed recommendations for rehabilitation interventions. Both guidelines recommend a comprehensive multi-disciplinary care approach. Detailed comparison, however, was not possible due to inconsistent recommendations, making it difficult to summarize rehabilitative care.
Conclusion: Despite rehabilitation being an integral component of the management of brain tumours, only a limited number of CPGs have incorporated recommendations for specific rehabilitation interventions. In order to improve clinical outcomes in this population future CPGs should incorporate rehabilitation interventions.
Brain tumours cause significant disability and morbidity. There are numerous published clinical practice guidelines (CPGs) for the management of brain tumours, and rehabilitation is recognized as an integral component of management of brain tumours. However, only limited numbers of these CPGs incorporate recommendations for specific rehabilitation interventions. To establish understanding of the issues of rehabilitation needs in brain tumours survivors, and synthesise evidence-based recommendations from rehabilitation perspective, published CPGs for brain tumours were critically appraised. Gaps in current literature were identified, and need of incorporation of rehabilitation interventions are highlighted. This is for future direction/recommendations in developing new CPGs to guide clinicians and to improve clinical outcomes in this population.
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