Abstract
BackgroundAttempts at measuring quality of rehabilitation care are hampered by a gap in knowledge translation of evidence-based approaches and lack of consensus on best practices. However, adoption of evidence-based best practices is needed to minimize variations and improve quality of care. Therefore, the objective of this project was to describe a process for assessing the quality of evidence of clinical practices in traumatic brain injury (TBI) rehabilitative care.MethodsA multidisciplinary team of clinicians developed discipline-specific clinical questions using the Population, Intervention, Control, Outcome process. A systematic review of the literature was conducted for each question using Pubmed, CINAHL, PsychInfo, and Allied Health Evidence databases. Team members assessed the quality, level, and applicability of evidence utilizing a modified Oxford scale, the Agency for Healthcare Research and Quality Methods Guide, and a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation scale.ResultsDraft recommendations for best-practice were formulated and shared with a Delphi panel of clinical representatives and stakeholders to obtain consensus.ConclusionEvidence-based practice guidelines are essential to improve the quality of TBI rehabilitation care. By using a modified quality of evidence assessment tool, we established a process to gain consensus on practice recommendations for individuals with TBI undergoing rehabilitation.
Highlights
Attempts at measuring quality of rehabilitation care are hampered by a gap in knowledge translation of evidence-based approaches and lack of consensus on best practices
Quality of evidence Based on the results of the quality of evidence assessment table, a draft recommendation was created using GRADE recommendation formatting
A conference call was held to discuss the impetus of the study, history regarding the TBI Model System (TBIMS), background information regarding the quality of evidence classification schemes employed in this study, and the process of draft recommendation development
Summary
Attempts at measuring quality of rehabilitation care are hampered by a gap in knowledge translation of evidence-based approaches and lack of consensus on best practices. To further compound lack of a uniform approach to rehabilitation, the current literature supporting care practices in TBI rehabilitation does not allow for the identification of evidence-based care guidelines for optimal dose or intensity of therapy, the ideal timing of therapy in the recovery process, or the necessary modifications for subpopulations. This is due to variability in care practices and a lack of rigorously executed research including randomized controlled trials [6, 9, 13]. The manuscript describes the process we have developed, so that it may be replicated by other groups as practitioners and researchers in the field of TBI continue to strengthen the knowledge base
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