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Table 3 Included guidelines, evidence sources and total AGREE score

From: Standardising evidence strength grading for recommendations from multiple clinical practice guidelines: a South African case study

Clinical practice guideline Acronym Year Source of evidence AGREE score
American Heart Association/American Stroke Association (rehabilitation guideline) AHA/ASA 2015 Relevant articles on adults using computerised searches of the medical literature through 2014 64.9% (mod)
American Occupational Therapy Association (sourced through Guidelines Clearing House AHRQ) AOTA 2013 Databases and sites searched included Medline, PsycINFO, CINAHL, AgeLine, and OTseeker, consolidated information sources(Cochrane Database of Systematic Reviews, Campbell Collaboration); reference lists from articles included in the systematic reviews were examined, and selected journals were hand searched 72.5% (mod)
American National Guidelines Clearing House summary (sourced through AHRQ) AHRQ 2013 Commissioned by and extracted from NICE rehabilitation guidelines (2013) (based on NICE methods). A panel of independent multidisciplinary experts debated the findings and wrote recommendations 73.2% (mod)
Australian Council on Safety and Quality in Health Care ACSQHC 2015 Australian clinical practice guidelines, standards and policies were identified from
• the clinical practice guideline portal of the National Health and Medical Research Council (NHMRC)
• websites of professional colleges and organisations
• websites of state and territory health departments and agencies
• internet search using various search engines.
International clinical practice guidelines
• guideline clearing houses such as the Agency for Healthcare Research and Quality (AHRQ) and Guidelines International Network (GIN)
• websites of guideline developers, such as the UK’s National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guideline Network (SIGN).
Other high-level evidence was identified by searching
• the Cochrane Collaboration for systematic reviews and meta-analyses
• medical literature databases (Medline, Embase) for systematic reviews and meta-analyses.
27.5% (poor)
Australian Stroke Foundation ASF 2017 Update evidence search using primary and secondary literature from library databases, Cochrane Collaboration, high quality international guidelines NB search strategy similar to all previous versions of ASF guidelines 63.0% (poor)
Canadian stroke guidelines CSG 2015 Methods based on the Practice Guideline Evaluation and Adaptation Cycle (PGEAC) [54]. Systematic literature search w for each topic area by independent contract methodologists. Updated literature searches built on previous reviews from 2012 to 2015, which overlapped the previous search time frame by 6 months to ensure high catchment of key articles within that time frame. The writing group was provided with comprehensive evidence tables that include summaries of all high-quality evidence identified through the literature searches. 85.1% (high)
Dept. of Defence, Veterans Association Management of Stroke Guidelines VA/DoD 2010 Recommendations for the management of stroke rehabilitation were derived through a rigorous methodological approach:
• Determining appropriate criteria such as effectiveness, efficacy, population benefit, or patient satisfaction
• Reviewing literature to determine the strength of the evidence in relation to these criteria
• Formulating the recommendations and grading the level of evidence supporting the recommendation
Findings were reviewed by an expert working party and recommendations produced relevant to veterans’ needs.
74.6% (mod)
Malaysian stroke guideline   2016 A panel of committee members was appointed comprising of neurologists, a cardiologist and a radiologist from the Ministry of Health, universities and the private sectors. Authors from the first CPG were invited to contribute on new updates before being discussed by panel members. The discussion started from early 2010 before being finalised and sent for the appointed reviewers. The group members met several times throughout the development of the guideline. All retrieved literature were appraised by individual members and subsequently presented for discussion during group meetings. All statements and recommendations formulated were agreed collectively by members of the Expert Panel. Where the evidence was insufficient the recommendations were derived by consensus of the Panel. The draft was then sent to local external reviewers for comments. The level of recommendation and the grading of evidence used in this guideline was adapted from the U.S./Canadian Preventive Services Task Force and the Guidelines for Clinical Practice Guideline, Ministry Of Health Malaysia 2003. The principles and layout follows the methodology stated in the Guidelines for Clinical Practice Guidelines booklet published by the Medical Development division of the Ministry of Health Malaysia. A standard methodology based on a systematic review of current evidence was used to look at the literature. These guidelines have been presented to the Chairman of the Health Technology Assessment and Clinical Practice Guidelines Council of the Ministry of Health Malaysia for review and approval. 81.9% (high)
New Zealand Guidelines Group NZGG 2010 Builds on the ASF search 2009. Systematic identification of relevant studies was conducted between May and August 2009, EMBASE, Medline and Cochrane databases were used. CINAHL and Psychinfo databases were searched where relevant. The PEDro database was used to check PT studies. A second updated search of the literature up to 19 February 2010 using Medline and EMBASE databases was conducted. Updated Cochrane reviews were also searched and included. Economic studies were included where available 73.6% (mod)
National Institute for Health and Clinical Excellence NICE 2013 De novo literature reviews were undertaken including evidence from economic studies, consensus was sought on the evidence findings for each question 75.4% (high)
NSW Agency for Clinical Innovation NSW ACI 2016 2015 National Acute Stroke Services, Framework by the National Stroke Foundation; 2015 Acute Stroke Clinical Care Standard and Indicator Specification by ACSQHC; 2010 Clinical Guidelines for Stroke Management NSF; 2015 Focused Update of the 2013 Guidelines for the Early Management of Patients with Acute Ischemic Stroke Regarding Endovascular Treatment by the American Heart Association/American Stroke Association; NSW ACI Stroke Reperfusion Program Evaluation Report; 2015; Bureau of Health Information, The Insight Series, 30-day mortality following hospitalisation, five clinical conditions. July 2009–2012 (7); Middleton S et al. ‘Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial’ Lancet 378(9804): 1699–706.(20) 65.6% (mod)
Royal College of Physicians RCP 2012 Systematic searching of computerised databases Medline, AMED, CINAHL, Psychinfo and Embase. The Cochrane Collaboration database, SIGN and NICE; Health Technology Appraisal (HTA) reports; 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. 90.2% (high)
South Australian Dept. of Health Stroke Network SA Dept. of Health SN 2017 Expert input 79.0% (mod)
Scottish Intercollegiate Guidelines Network (dysphasia, rehabilitation) SIGN 2010, 2010 De novo and updating searches as per all SIGN activities (comprehensive systematic reviewing, critical appraisal, independent data extraction) 81.5% (mod)
South African Stroke Society SASS 2010 Consensus based on AHA/ASA guidelines 51.8% (poor)