Management of Spasticity in Moderate and Severe Traumatic Brain Injury

Evaluation of Clinical Practice Guidelines

Loyal Pattuwage, John Olver, Caius Martin, Francis Lai, Loretta Piccenna, Russell Gruen, Peter Bragge

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Introduction: Moderate to severe traumatic brain injury (TBI) can result in development of spasticity, which adversely affects function and quality of life. Given the foundation of optimal clinical practice is use of the best available evidence, we aimed to identify, describe, and evaluate methodological quality of evidence-based spasticity clinical practice guidelines (CPGs). Methods: A comprehensive search for CPGs encompassed electronic databases and online sources. Eligible CPGs were evaluated using the validated Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Results: Five CPGs were eligible for review; 2 were specific to acquired brain injury and 1 to TBI. The 3 brain injury-specific CPGs contained 423 recommendations overall, but only 8spasticity recommendations. On the basis of AGREE appraisals, all CPGs performed well in the areas of reporting scope and purpose; clearly presenting recommendations; including various stakeholders in the CPG developmentprocess; and reporting conflict of interest. However, only one CPG performed adequately on describing facilitators and barriers to implementation, advice, and tools on how to implement recommendations and provision of audit criteria. Intraclass correlation coefficient (ICC) for agreement between raters showed high agreement (ICC > 0.80) for most guidelines. Conclusion: Given the unique etiological features and treatment challenges associated with managing spasticity after TBI,more TBI-specific spasticity CPGs are required. These should incorporate information on the facilitators and barriers to implementation, advice on implementing recommendations, and audit criteria.
Original languageEnglish
Pages (from-to)E1-E12
Number of pages12
JournalJournal of Head Trauma Rehabilitation
Volume32
Issue number2
DOIs
Publication statusPublished - 2017

Cite this

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title = "Management of Spasticity in Moderate and Severe Traumatic Brain Injury: Evaluation of Clinical Practice Guidelines",
abstract = "Introduction: Moderate to severe traumatic brain injury (TBI) can result in development of spasticity, which adversely affects function and quality of life. Given the foundation of optimal clinical practice is use of the best available evidence, we aimed to identify, describe, and evaluate methodological quality of evidence-based spasticity clinical practice guidelines (CPGs). Methods: A comprehensive search for CPGs encompassed electronic databases and online sources. Eligible CPGs were evaluated using the validated Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Results: Five CPGs were eligible for review; 2 were specific to acquired brain injury and 1 to TBI. The 3 brain injury-specific CPGs contained 423 recommendations overall, but only 8spasticity recommendations. On the basis of AGREE appraisals, all CPGs performed well in the areas of reporting scope and purpose; clearly presenting recommendations; including various stakeholders in the CPG developmentprocess; and reporting conflict of interest. However, only one CPG performed adequately on describing facilitators and barriers to implementation, advice, and tools on how to implement recommendations and provision of audit criteria. Intraclass correlation coefficient (ICC) for agreement between raters showed high agreement (ICC > 0.80) for most guidelines. Conclusion: Given the unique etiological features and treatment challenges associated with managing spasticity after TBI,more TBI-specific spasticity CPGs are required. These should incorporate information on the facilitators and barriers to implementation, advice on implementing recommendations, and audit criteria.",
author = "Loyal Pattuwage and John Olver and Caius Martin and Francis Lai and Loretta Piccenna and Russell Gruen and Peter Bragge",
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Management of Spasticity in Moderate and Severe Traumatic Brain Injury : Evaluation of Clinical Practice Guidelines. / Pattuwage, Loyal; Olver, John; Martin, Caius; Lai, Francis; Piccenna, Loretta; Gruen, Russell; Bragge, Peter.

In: Journal of Head Trauma Rehabilitation, Vol. 32, No. 2, 2017, p. E1-E12.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Management of Spasticity in Moderate and Severe Traumatic Brain Injury

T2 - Evaluation of Clinical Practice Guidelines

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AU - Olver, John

AU - Martin, Caius

AU - Lai, Francis

AU - Piccenna, Loretta

AU - Gruen, Russell

AU - Bragge, Peter

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