Brain tumour rehabilitation guidelines
consensus. Furthermore, as aggregate scoring across domains
is not recommended by the AGREE Enterprise, the AGREE II-
Global Rating Scale (AGREE II-GRS) was used to rate overall
quality on a 7-point scale (from 1 = lowest quality to 7 = highest
quality) and categorized as: “excellent quality”= score 7/7,
“high quality” = 5–6/7, “moderate quality” = 4/7 and “poor
quality” = 0–3/7. The AGREE-II instrument is a validated
appraisal tool for thorough quality assessment of guidelines
and is widely used (18–24).
Data extraction and classification of recommendations
A standard pro-forma was used for data extraction from all
CPGs. The form included: publication and search date, objec-
tives/scope, methodology used, evidence-supported recommen-
dation, and limitations. Three authors (JK, KN, BA) extracted
the evidence-based recommendations, specifically for the
rehabilitation, and categorized them into the following groups:
(i) initial clinical assessment, (ii) observation and management,
(iii) triage and discharge planning, and (iv) patient information
and patient follow-up.
RESULTS
The searches retrieved 458 published titles and ab-
stracts. Ten titles met the inclusion criteria and were
selected for closer scrutiny. Full texts of these articles/
reports were retrieved and 3 reviewers (JK, KN, BA)
performed the final selection. One report that met
inclusion criteria was identified from bibliographies
of relevant articles. The search did not identify any
specific guidelines for rehabilitation of persons with
BT. Of the 11 CPGs identified, only the following 2
generic CPGs for management of BT which included
different rehabilitation interventions, fulfilled the in-
clusion criteria for this review (Table II):
• Australian Cancer Network. Adult Brain Tumour
Guidelines Working Party. CPGs for the Manage-
91
ment of Adult Gliomas: Astrocytomas and Oligo-
dendrogliomas. Cancer Council Australia, Australian
Cancer Network and Clinical Oncological Society
of Australia Inc., Sydney 2009 (hereafter referred
as “ACN” guidelines) (25).
• National Institute for Health and Clinical Excellence
(NICE) (UK). Improving outcomes for people with
brain and other CNS tumours: the Manual, National
Collaborating Centre for Cancer, London June 2006
(hereafter referred as “NICE” guidelines) (26).
A detailed description of the included guidelines
and a list of excluded guidelines are given in Table III.
Quality assessment of included clinical practice
guidelines
The 2 included CPGs were critiqued qualitatively using
the AGREE-II tool, with a global rating score of 5 out of
7. Overall, the ACN CPG scored better than the NICE
CPG (total score = 115 vs 107). All 3 authors rated the
guidelines “Moderate”, indicating the need for some
modification for clinical applicability. The kappa level
of agreement between the authors for AGREE II assess-
ment was 0.81. A summary of the guidelines’ assessment
AGREE II scores is shown in Table IV. An overview of
the quality assessment of the included CPGs for each of
the 6 AGREE-II domains is set out below.
Domain 1: Scope and purpose (AGREE Items 1–3). In
general, both CPGs outlined the objectives and overall
aim, the specific health questions, and the target popu-
lation. However, both CPGs failed to provide clear or
concise information on interventions, and outcomes;
and did not specifically describe the state of disease,
clinical condition and exclusion criteria for the target
population.
Table II. Characteristics of the included clinical practice guidelines
Developers
Country of origin, year
Clinical Oncological Society of Australia Australia, 2009
Australian Cancer Council (25)
National Collaborating Centre for
Cancer (26)
UK, 2006, (currently being updated)
Target population Grade and level of evidence used
Adult gliomas: astrocytoma and
Oligodendro-gliomas National Health and Medical Research
Council (NHMRC)
Brain and other central nervous system National Institute of Clinical Excellence
tumours
(NICE) Methodology manual
Table III. List of excluded clinical practice guidelines
Developers Year published Reason for exclusion
Royal College of Physicians, Overview: brain tumour diagnosis and management
EANO, Guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas
EANO, Guideline for the diagnosis and treatment of anaplastic glioma
EANO-ESMO, CPGs for diagnosis, treatment and follow-up of patients with leptomeningeal
metastasis from solid tumours
ESMO, High-grade glioma: CPGs for diagnosis, treatment and follow-up
NCCN, Guidelines Insight: Central Nervous System Cancer
ABTA, Care of the adult patient with a brain tumor
EANO, Guidelines for palliative care in adults with glioma
EANO, Guidelines for the diagnosis and treatment of anaplastic gliomas and glioblastoma 2004
2017
2014
2017 Does
Does
Does
Does
2014
2017
2014
2017
2014 Does not include rehabilitation
Does not include rehabilitation
1 narrative paragraph on rehabilitation
Does not include rehabilitation
1 narrative paragraph on rehabilitation
not
not
not
not
include
include
include
include
rehabilitation
rehabilitation
rehabilitation
rehabilitation
ABTA: American Brain Tumor Association; EANO: European Association for Neuro-Oncology; ESMO: European Society for Medical Oncology; NCCN: National
Comprehensive Cancer Network.
J Rehabil Med 51, 2019