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Table 2 Examples of recommendations, Adopt–Contextualise–Adapt decisions (Fig. 1) and implementation plans [5]

From: A South African experience in applying the Adopt–Contextualise–Adapt framework to stroke rehabilitation clinical practice guidelines

  Evidence strengtha,b Recommendations Endorsement Implementation plans
1. There are consistent strong recommendations that people who suffer from stroke should be seen by a multidisciplinary/inter-professional/interdisciplinary stroke team for medical and rehabilitation assessment and management. The team consists of doctors, nurses, physiotherapists, occupational therapists, speech language therapists, social workers, dieticians, clinical neuropsychologists/clinical psychologists B2 Increase the rehabilitation workforce (requiring at least 5 years for students to graduate from new university programmes)
Increase funding to support a multidisciplinary stroke workforce (requiring at least 2 years to lobby, plan and train)
2. There are consistent suggestions that all members of the multidisciplinary team should have specialised training in stroke care and recovery A2 Increase the amount of tertiary training in rehabilitation in medical, nursing and allied health programmes (requiring a 2–3 year timeframe)
3. There are consistent strong recommendations that all patients who suffer from stroke should have access to specialist stroke service units with multidisciplinary team as early as the hyperacute–acute stages of stroke and up to discharge B2 Same solutions as for 1, but including changing opinions of hospital administrators, policy-makers and funders about the value of specialist stroke service units
4. There are consistent strong recommendations that rehabilitation should commence in the acute setting as soon as the person with stroke is medically safe and/or able to participate A1 There are no barriers to this, but it may be important to educate medical doctors to refer stroke suffers as quickly as possible for rehabilitation
5. There are consistent suggestions that a standard set of assessment tools should be used to assess rehabilitation needs throughout the patient journey; these should be valid, sensitive to detect change, simple to use and, if required, apply standard protocols to assist more complex assessment C2 Current international assessment tools require further evaluation for local contexts and fit to South African rehabilitation settings Local tools dealing with local outcome issues may need to be developed
  1. a is assigned when the composite recommendation is underpinned by three or more CPG recommendations that have a high strength of the body of evidence grading, and provide positive consistent recommendations [5]
  2. b is assigned when the composite recommendation is underpinned by three or more CPG recommendations that are supported by moderate strength of the body of evidence gradings, and provide positive consistent recommendations [5]