Development and adaptation of a Canadian clinical practice guideline for the rehabilitation of adults with moderate-to-severe traumatic brain injury (tbi)

Abstract

A clinical practice guideline (CPG) for traumatic brain injury (TBI) rehabilitation is under development in Ontario and Québec, Canada. Multiple stakeholders (clinicians/managers, physicians, researchers, and decision-makers) were consulted regarding their perceptions about their needs and the CPG content/format and implementation and participated as experts in a meeting to achieve consensus on the main recommendations to include in the CPG; to modify recommendations requiring adaptation, and to identify performance indicators to measure practice related to the recommendations. To report on the consensus process results. Sixty TBI experts (i.e. clinicians from multiple disciplines, researchers, managers, decision-makers and community associations) participated. Using prepared lists of recommendations based on scientific evidence and existing guidelines about the organization of rehabilitation services (e.g. case management) and the rehabilitation of specific brain injury-related impairments (e.g. fatigue and sleep disorders), experts assembled in 6 working groups produced a preliminary set of recommendations. For the organization of services, 39 new recommendations were added to the 71 existing recommendations; 78 new recommendations were added to the 142 related to impairments, for a total of 330 recommendations. Examples of performance indicators included patient satisfaction and chart audit (presence/absence of recommended assessment/intervention). A first set of guidelines was produced and they will be refined through further consultation with the experts who will prioritise the recommendations for the final version of the CPG.