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Quality of Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury

Bragge, Peter PhD; Pattuwage, Loyal MPH; Marshall, Shawn MD, FRCPC; Pitt, Veronica PhD; Piccenna, Loretta PhD; Stergiou-Kita, Mary PhD; Tate, Robyn L. PhD; Teasell, Robert MD, FRCPC; Wiseman-Hakes, Catherine PhD; Kua, Ailene MSc; Ponsford, Jennie PhD; Velikonja, Diana PhD; Bayley, Mark MD, FRCPC

Section Editor(s): Bayley, Mark Theodore MD; Bragge, Peter PhD; Ponsford, Jennie PhD

Journal of Head Trauma Rehabilitation: July/August 2014 - Volume 29 - Issue 4 - p 277–289
doi: 10.1097/HTR.0000000000000066
Original Articles

Introduction: Cognitive rehabilitation following traumatic brain injury can aid in optimizing function, independence, and quality of life by addressing impairments in attention, executive function, cognitive communication, and memory. This study aimed to identify and evaluate the methodological quality of clinical practice guidelines for cognitive rehabilitation following traumatic brain injury.

Methods: Systematic searching of databases and Web sites was undertaken between January and March 2012 to identify freely available, English language clinical practice guidelines from 2002 onward. Eligible guidelines were evaluated using the validated Appraisal of Guidelines for Research and Evaluation II instrument.

Results: The 11 guidelines that met inclusion criteria were independently rated by 4 raters. Results of quality appraisal indicated that guidelines generally employed systematic search and appraisal methods and produced unambiguous, clearly identifiable recommendations. Conversely, only 1 guideline incorporated implementation and audit information, and there was poor reporting of processes for formulating, reviewing, and ensuring currency of recommendations and incorporating patient preferences. Intraclass correlation coefficients for agreement between raters showed high agreement (intraclass correlation coefficient > 0.80) for all guidelines except for 1 (moderate agreement; intraclass correlation coefficient = 0.76).

Conclusion: Future guidelines should address identified limitations by providing implementation information and audit criteria, along with better reporting of guideline development processes and stakeholder engagement.

National Trauma Research Institute, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia (Drs Bragge, Pitt, and Piccenna and Mr Pattuwage); The Ottawa Hospital Rehabilitation Center, University of Ottawa, Ottawa, Ontario, Canada (Dr Marshall); University of Toronto and Toronto Rehabilitation Institute, Toronto, Ontario, Canada (Dr Stergiou-Kita); UHN-Toronto Rehabilitation Institute and Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (Dr Bayley); Rehabilitation Studies Unit, Sydney Medical School - Northern, The University of Sydney, New South Wales, Australia (Professor Tate); Lawson Research Institute and Western University, London, Ontario, Canada (Dr Teasell); Bloorview Research Institute, Holland, Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada (Dr Wiseman-Hakes); Toronto Rehabilitation Institute, Toronto, Ontario, Canada (Ms Kua); Monash-Epworth Rehabilitation Research Centre, Epworth Hospital and School of Psychological Sciences, Monash University, Victoria, Australia (Professor Ponsford); and Acquired Brain Injury Program, Hamilton Health Sciences, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Velikonja).

Corresponding Author: Peter Bragge, PhD, National Trauma Research Institute, Monash University and The Alfred Hospital, Level 4, 89 Commercial Road, Melbourne, Australia 3004 (

This project was funded through Monash University's Strategic Grants Scheme (Lead CI: Peter Bragge) and the Ontario Neurotrauma Foundation (Lead CI: Mark Bayley).

The authors gratefully acknowledge Lyn Turkstra for her editorial input to this article.

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins