Development and implementation of evidence-based practice guidelines for psychological interventions in post-stroke rehabilitation

Abstract

Background: Main objectives of neurological rehabilitation are improvement of impairment and cognitive performance, as well as promotion of activities and participation. It is conducted in a multidisciplinary and setting, and psychological diagnostics and interventions are a pivotal part of it. Goal of this project was to develop practice guidelines for psychological interventions in the rehabilitation of stroke patients (funding: German Statutory Pension Insurance). Methods: In order to foster implementation of the recommendations, we incorporated the following steps: 1) in order to base the content on best available evidence, we conducted a systematic search for guidelines, reviews and literature, 2) we surveyed all neurological rehabilitation facilities in Germany for information on current structures and practices, and 3) we discussed a preliminary draft of the recommendations with national experts (psychologists, physicians, scientists, therapists for oc[removed]void(0);cupational, speech and physical therapy, nurses, patients). In addition, a sample of stroke patients was asked for their opinion on certain recommendations. In a final step we then consulted psychologists and medical directors of all neurological rehabilitation centres (N=344 questionnaires; N=172 centers), and asked for their appraisal on each recommendation (approval, rejection, or alternate suggestions). Findings: Response rate was 35% (n=121). We received 870 suggestions. Approval was 97% on average (range: 88-100%). Conclusion: The broad participation of clinicians, scientists and patients allowed us to develop detailed recommendations based on current evidence and best practice. Now, evidence-based and widely accepted recommendations for psychological interventions in post-stroke rehabilitation are available. We expect that their implementation will improve neurological rehabilitation.