© 2007 The Authors. Journal compilation © 2007 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 13 (2007) 657–664 657 Journal of Evaluation in Clinical Practice ISSN 1356-1294 Blackwell Publishing LtdOxford, UKJEPJournal of Evaluation in Clinical Practice1356 1294© 2006 The Authors; Journal compilation © 2006 Society/Blackwell Publishing Ltd2006134657664Original Article Quality of stroke care clini cal guidelinesA. Hurdowar et al . Quality of stroke rehabilitation clinical practice guidelines Amanda Hurdowar MSc, 1 Ian D. Graham PhD, 2 Mark Bayley MD FRCPC, 3 Margaret Harrison RN PhD, 4 Sharon Wood-Dauphinee PhD PT 5 and Sanjit Bhogal MSc 6 1 Project Coordinator, Toronto Rehabilitation Institute, Toronto, ON, Canada 2 Associate Professor, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, and Associate Director and Senior Social Scientist, Clinical Epidemiology, Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, ON, Canada 3 NeuroRehabilitation Program Medical Director, Toronto Rehabilitation Institute, Toronto, and Associate Professor, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada 4 Associate Professor, Queen’s University School of Nursing, Community Health and Epidemiology, Kingston, ON, Canada 5 Professor, School of Physical and Occupational Therapy, McGill University, Montreal, PQ, Canada 6 Department of Epidemiology and Biostatistics, McGill University, Montreal, PQ, Canada Abstract Background and purpose Clinical practice guidelines (CPGs) are systematically devel- oped statements that assist practitioners to provide appropriate evidence-based care. The purpose of this study was to evaluate the quality of currently published CPGs for stroke care and to examine the reliability and validity of the appraisal of guidelines, research and evaluation (AGREE) instrument. Methods Multiple databases and Internet resources were searched for stroke care CPGs. Guidelines included were published in English or French from 1998 to 2004 and developed by a group process. Four appraisers evaluated each CPG using the AGREE instrument. The AGREE consists of 23 items, ranked on a 4-point Likert scale, that is organized into six domains. A standardized score is calculated separately for each domain and ranges from 0 to 100. Results Eight guidelines were identified. The AGREE quality scores were high for the ‘scope and purpose’ domain (mean ± SE = 71.2 ± 5.48, intra-class correlation (ICC) = 0.66), and ‘clarity and presentation’ (mean ± SE = 70.6 ± 4.43, ICC = 0.66). There was wide variation in ratings of ‘rigour of development’ (mean ± SE = 60.7 ± 7.1, ICC = 0.75) and ‘stakeholder involvement’ (mean ± SE = 52.6 ± 7.14, ICC = 0.89). The ‘editorial inde- pendence’ (mean ± SE = 38.1 ± 8.72, ICC = 0.88) and ‘applicability’ (mean ± SE = 35.1 ± 4.93, ICC = 0.75) had the lowest scores. Conclusions There is considerable variability in quality of stroke care guidelines but stroke guidelines score higher on the AGREE rigour of development domain than CPGs from other medical fields. The Scottish Intercollegiate Guideline Network, Veterans Affairs/Department of Defence, Royal College of Physicians, and the New Zealand Guide- lines Group consistently scored the highest across the domains. Stroke rehabilitation clinicians should consider these results in selecting a guideline. CPG development groups can improve their AGREE scores by considering the cost of implementing their CPGs, pilot testing their CPGs, recording conflict of interest of development panel members and providing tools supporting application of the their CPGs. Introduction Stroke is the leading cause of long-term adult disability in Canada with over 300 000 people living with the after-effects of stroke each year [1]. Organized post-stroke care has been shown to reduce mortality and the burden of disability when it is provided in a multidisciplinary acute stroke unit [2]. However, large variations in service provided by teams, rising health care costs, increased demand for care, and the ageing population have fuelled interest in developing and using clinical practice guidelines (CPGs) to facili- tate organized care [3]. CPGs are ‘systematically developed state- ments used to assist practitioners to make patient decisions about Keywords AGREE, clinical practice guidelines, evidence- based practice, rehabilitation, stroke Correspondence Amanda Hurdowar Quality & Risk Management The Hospital for Sick Children 555 University Avenue Room 2206 Toronto ON M5G 1X8 Canada E-mail: amanda.hurdowar@sickkids.ca Accepted for publication: 23 January 2006