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Kim, Kim, Lee, Chang, Kim, Pyun, Yoo, Ohn, Park, Oh, Lim, Jung, Ryu, Im, Jee, Seo, Rah, Park, Sohn, Chun, Shin, Lee, Lee, Park, Park, Paik, Lee, Lee, Koh, Kim, Park, Shin, Ko, Kim, Yoo, Kim, Oh, Chang, Jung, Kim, Kim, Kim, Park, Lee, Hwang, and Song: Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016
Guideline

Brain & Neurorehabilitation 2017; 10(Suppl 1): e11.

Published online: 11 October 2017

DOI: https://doi.org/10.12786/bn.2017.10.e11

Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016

Deog Young Kim1, Yun-Hee Kim2, Jongmin Lee3, Won Hyuk Chang2, Min-Wook Kim4, Sung-Bom Pyun5, Woo-Kyoung Yoo6, Suk Hoon Ohn6, Ki Deok Park7, Byung-Mo Oh8, Seong Hoon Lim4, Kang Jae Jung9, Byung-Ju Ryu10, Sun Im4, Sung Ju Jee11, Han Gil Seo8, Ueon Woo Rah12, Joo Hyun Park4, Min Kyun Sohn11, Min Ho Chun13, Hee Suk Shin14, Seong Jae Lee15, Yang-Soo Lee16, Si-Woon Park17, Yoon Ghil Park1, Nam Jong Paik8, Sam-Gyu Lee18, Ju Kang Lee7, Seong-Eun Koh3, Don-Kyu Kim19, Geun-Young Park4, Yong Il Shin20, Myoung-Hwan Ko21, Yong Wook Kim1, Seung Don Yoo22, Eun Joo Kim23, Min-Kyun Oh14, Jae Hyeok Chang20, Se Hee Jung8, Tae-Woo Kim24, Won-Seok Kim8, Dae Hyun Kim25, Tai Hwan Park26, Kwan-Sung Lee27, Byong-Yong Hwang28, Young Jin Song29

1Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea.

2Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.

3Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea.

4Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea.

5Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Korea.

6Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea.

7Department of Rehabilitation Medicine, Gachon University College of Medicine, Korea.

8Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea.

9Department of Physical Medicine and Rehabilitation, Eulji University Hospital & Eulji University School of Medicine, Korea.

10Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Korea.

11Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Korea.

12Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Korea.

13Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea.

14Department of Rehabilitation Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Korea.

15Department of Rehabilitation Medicine, College of Medicine Dankook University, Korea.

16Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Korea.

17Department of Rehabilitation Medicine, Catholic Kwandong University International St Mary's Hospital, Korea.

18Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Korea.

19Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Korea.

20Department of Rehabilitation Medicine, Pusan National University Hospital, Korea.

21Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Korea.

22Department of Physical Medicine and Rehabilitation, Kyung Hee University College of Medicine, Korea.

23Department of Physical Medicine and Rehabilitation, National Rehabilitation Hospital, Korea.

24TBI rehabilitation center, National Traffic Injury Rehabilitation Hospital, College of Medicine, The Catholic University of Korea, Korea.

25Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Korea.

26Department of Neurology, Seoul Medical Center, Korea.

27Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea.

28Department of Physical Therapy, Yong-In University College of Health & Welfare, Korea.

29Department of Rehabilitation Medicine, Asan Medical Center, Korea.

Correspondence to Deog Young Kim. Department of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-3714, Fax: +82-2-3463-7585, kimdy@yuhs.ac

Copyright © 2017. Korea Society for Neurorehabilitation

Korea Society for Neurorehabilitation

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

“Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” is the 3rd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 2nd edition published in 2014. Forty-two specialists in stroke rehabilitation from 21 universities and 4 rehabilitation hospitals and 4 consultants participated in this update. The purpose of this CPG is to provide optimum practical guidelines for stroke rehabilitation teams to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. The recent two CPGs from Canada (2015) and USA (2016) and articles that were published following the 2nd edition were used to develop this 3rd edition of CPG for stroke rehabilitation in Korea. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. Good Practice Point was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” consists of ‘Chapter 1; Introduction of Stroke Rehabilitation’, ‘Chapter 2; Rehabilitation for Stroke Syndrome, ‘Chapter 3; Rehabilitation for Returning to the Society’, and ‘Chapter 4; Advanced Technique for Stroke Rehabilitation’. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” will provide direction and standardization for acute, subacute and chronic stroke rehabilitation in Korea.

Keywords: Stroke, Rehabilitation, Clinical practice guideline, Korea

Figures and Tables

Fig. 1
Algorithm of stroke rehabilitation
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Table 1

Appraisal of Foreign Stroke CPG with K-AGREE II

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Clinical practice guideline Appraisal Rigour of development Rigour percentage Total score Overall assessment Result
Canada 1 36 67% 120 6 Adoption
2 39 126 6
USA 3 42 74% 119 7 Adoption
4 41 120 7
United Kingdom 5 44 82% 113 6 Exclusion
6 48 138 6
Table 2

Level of Evidence

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Level Evidence
1++ High quality meta-analyses, systemic reviews of RCTs, or RCTs with a very low risk of bias
1+ Well conducted meta-analyses, systemic reviews, or RCTs with a low risk of bias
1- Meta-analyses, systemic reviews, or RCTs with a high risk of bias
2++ High quality systemic reviews of case control or cohort studies
High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal
2+ Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal
2− Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal
3 Non-analytic studies, eg case reports, case series
4 Expert opinion
RCT; randomized controlled trials
Table 3

Grade of Recommendation

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Grade Recommendation
Note: The grade of recommendation relates to the strength of the evidence on which the recommendation is based. It does not reflect the clinical importance of recommendation.
A At least one meta-analysis, systemic review, or RCT related as 1++,
and directly applicable to the target population; or
A body of evidence consisting principally of studies related as 1+,
directly applicable to the target population, and demonstrating overall consistency of results
B A body of evidence including studies related as 2++,
directly applicable to the target population, and demonstrating overall consistency of results; or
Extrapolated evidence from studies related as 1++ or 1+
C A body of evidence including studies related as 2+,
directly applicable to the target population, and demonstrating overall consistency of results; or
Extrapolated evidence from studies related as 2++
D Evidence level 3 or 4; or
Extrapolated evidence from studies related as 2+
GPP Recommended best practice based on the clinical experience of the guideline developmental group.
RCT; randomized controlled trials

Notes

Conflict of Interest The authors have no potential conflicts of interest to disclose.

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