The process used to identify key topic areas and core reference guidelines is outlined below.
- An ongoing structured literature review is conducted every two to three months to monitor emerging evidence and new or updated stroke-related guidelines.
- Scans of the primary research literature focused on meta-analyses, systematic reviews, randomized trials, quasi-experimental studies, other related guidelines and reports, and Canadian consensus statements by healthcare professional groups.
- The strength of the research evidence was graded using a standardized grading system (See Appendix 6). In some areas, the levels of evidence for a given topic varied among selected guidelines or research papers depending on the nature of the research. The totality of the information for each topic provided a comprehensive understanding of the strength of the evidence, the state of the research, and gaps for future inquiry.
- A detailed literature search for international stroke-related guidelines was also undertaken. The Appraisal of Guidelines Research and Evaluation (AGREE) tool was applied to determine the quality of the guidelines.4 This tool can be used to assess the process of guideline development based on six domains: identification of a clinical area to promote best practice, stakeholder involvement, rigour of development, clarity and presentation, applicability, and editorial independence. Based on the results of the appraisals, several guidelines met our criteria to be considered as ‘reference guidelines’ for the our development process.5-52
- Once the high-quality guidelines were identified, a content review was conducted to identify a list of stroke topic areas that were supported by the highest levels of evidence. A secondary list of topic areas with lower levels of supporting evidence but considered to be key system drivers (such as acute diagnostic imaging with computed tomography scans) was also compiled.
- Potential topics that emerged from the research and guideline review were compiled into a “Topic Matrix” to allow easy comparison by topic and strength of evidence.
- The topic areas and levels of supporting evidence were reviewed and debated by the Working Group. Using a consensus model, a final list of stroke topic areas that were considered most relevant to optimal stroke care in Canada was developed.
- Topic areas were assigned to one of eight task groups to develop detailed recommendation statements.
Refer to Appendix 6 for the evidence grading system used.
Refer to Appendix 7 for a list of guidelines and significant research trials that were considered during the 2010 update process.