Systematic Development of Practice Guidelines for Psychological Interventions in Stroke Rehabilitation.

Purpose: We aimed to develop evidence-based practice guidelines that can support decision-making in individual cases and be used by a multidisciplinary team in stroke rehabilitation. Materials and methods: We conducted a literature search (step 1), and a survey of all neurological rehabilitation facilities in Germany concerning their structural working conditions and current practices (step 2). Based on this information, we drafted a first version of the practice guidelines, and discussed them with a group of experts (step 3). We also consulted concurrently with senior psychologists, head physicians (step 4), and patients after stroke (step 5). We revised the guidelines until consensus on the final version was reached (step 6). Results: Referring to the ICF for guidance, the practice guidelines comprise of psychological recommendations in five problem areas ("Participation - Major Aims of Rehabilitation", "Cognition", "Affect & Behavior", "Risk Factors", and "Specific Problems & Aspects"), and provide preliminary remarks on general frame conditions and procedural requirements. The practice guidelines were widely accepted by head psychologists and physicians of in- and outpatient neurological rehabilitation with an average agreement of 97% (range: 88-100%). Conclusions: Our practice guidelines include detailed recommendations for psychological interventions that can guide individual decision-making by a multidisciplinary team. Specific aspects to foster implementation were considered, and attempts were made to promote their dissemination.