Review Protocol 1

DetailsAdditional commentsStatus
Review question ID1
Review questionWhat are the clinical/test utility of screening and assessment tools (developed and/or modified for critical care population) in identifying critical care adult patients at risk of physical functional impairment and non-physical dysfunctions such as psychological problems and cognitive impairment associated with their treatment experience and critical illness?
ObjectivesTo review the clinical/test utility of different screening and assessment tools designed and/or validated for identifying physical functional impairment and non-physical dysfunctions including psychological problems and cognitive impairment following a period of critical illness.The review does not cover service delivery issues.As per protocol, with exclusion of service delivery issues
LanguageEnglishAs per protocol
Study designCross-sectional studies, case control studies, RCTs, Cohort studiesAs per protocol
StatusPublished papers (full papers only)As per protocol
PopulationInclusion:
Adults with rehabilitation needs as a result of a period of critical illness that required level 2 and level 3 Critical Care.

Exclusion:
  • Adults receiving palliative care.
  • Clinical subgroups of patients whose specialist rehabilitation needs are already routinely assessed and delivered as part of their care pathway (for example, patients who received critical care as part of an elective pathway and who did not develop an unanticipated, ongoing critical illness, and in areas where published guidelines already exist such as head injury, myocardial infarction and stroke).
As per protocol, with exclusion of service delivery issues
Outcomes
  • Morbidity (physical functional status including swallowing and communication problems, psychological and cognitive dysfunction]
  • Clinical/Test utility including:

    sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, diagnostic odds ratio and area under the ROC analyses.

    test validity such as face validity, content validity, construct validity, criterion validity;

    test reliability such as internal reliability/consistency, test-retest reliability, inter-rater reliability.

Since the review question is more generally about clinical/test utility, not just solely focused on ‘diagnostic accuracy’ (i.e. sensitivity, specificity, PPV, NPV, LHR, DOR and area under the ROC), studies that reported test validity (eg. face validity, content validity, construct validity, criterion validity) and test reliability (e.g. internal reliability/consistency, test- retest reliability, inter-rater reliability) are also included.As per protocol, with exclusion of service delivery issues
Other criteria for inclusion/exclusion of studiesInclusion:
Only screening or assessment tools developed/derived or modified and validated within the general critical care population to identify general rehabilitation needs are included for review.

Exclusion:
Screening or assessment tools only designed or validated for specific critical care populations such as cardiac, stroke or neurological patients to identify patients who need specific rehabilitation such as cardiac rehabilitation, neurological rehabilitation and other organ-specific rehabilitations are excluded.
Reasons for strict inclusion and exclusion criteria are concern over spectrum bias* and clinical applicability.

*Spectrum bias – heterogeneity of test performance (i.e. sensitivity and/or specificity) of a test varying with different populations tested.

Example: the sample population chosen is not representative of the population at risk
As per protocol, with exclusion of service delivery issues
Search strategiesPlease see Appendix 3As per protocol, with exclusion of service delivery issues
Review strategies
  • NICE Diagnostic studies checklist (QUADAS tool) will be used to appraise included studies.
  • Evidence table and narrative summary will be used to summarise the evidence.
  • Where possible, a meta-analytic approach will be used to give an overall summary effect.
A meta-analysis was not undertaken because of heterogeneity across the included studies.
DetailsAdditional commentsStatus
Review question ID2
Review questionWhen is the best or optimal time for screening and assessing critical care adult patients at risk of physical functional impairment and non-physical dysfunctions such as psychological problems and cognitive dysfunction associated with their treatment experience and critical illness?
ObjectivesTo review the optimal timing for identifying or assessing general critical care patients with rehabilitation needs.The review does not cover service delivery issues.As per protocol, with exclusion of service delivery issues
LanguageEnglishAs per protocol
Study designCross-sectional studies, case control studies, RCTs, cohort studiesAs per protocol
StatusPublished papers (full papers only)As per protocol
PopulationInclusion:
Adults with rehabilitation needs as a result of a period of critical illness that required level 2 and level 3 Critical Care.

Exclusion:
  • Adults receiving palliative care.
  • Clinical subgroups of patients whose specialist rehabilitation needs are already routinely assessed and delivered as part of their care pathway (for example, patients who received critical care as part of an elective pathway and who did not develop an unanticipated, ongoing critical illness, and in areas where published guidelines already exist such as head injury, myocardial infarction and stroke).
As per protocol, with exclusion of service delivery issues
Outcomes
  • Morbidity (physical functional status including swallowing and communication problems, psychological and cognitive dysfunction).
  • Clinical/Test utility at different time-points including:

    sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, diagnostic odds ratio and area under the ROC analyses at different time-points.

    test validity such as face validity, content validity, construct validity, criterion validity at different time points.

    test reliability such as internal reliability/consistency, Test-retest reliability, Inter-rater reliability at different time points.

As per protocol, with exclusion of service delivery issues
Other criteria for inclusion/exclusion of studiesInclusion:
Only screening or assessment tools developed/derived or modified and validated within the general critical care population, and administered at different time points to identify general rehabilitation needs are included for the review.

Exclusion:
Optimal timing of screening or assessment tools only designed or validated for specific critical care populations such as cardiac, stroke or neurological patients to identify patients who need specific rehabilitation such as cardiac rehabilitation, neurological rehabilitation and other organ-specific rehabilitations are excluded.
Reasons for strict inclusion criterion were concerns over spectrum bias and clinical applicability.As per protocol, with exclusion of service delivery issues
Search strategiesPlease see Appendix 3As per protocol, with exclusion of service delivery issues
Review strategies
  • NICE Diagnostic studies checklist (QUADAS tool) will be used to appraise included studies.
  • Evidence table and narrative summary will be used to summarise the evidence.
  • Where possible, a meta-analytic approach will be used to give an overall summary effect.
A meta-analysis was not undertaken because of heterogeneity across the included studies.

From: 6.4 Appendix 4, Review protocols and evidence tables

Cover of Rehabilitation After Critical Illness
Rehabilitation After Critical Illness [Internet].
NICE Clinical Guidelines, No. 83.
Centre for Clinical Practice at NICE (UK).
Copyright © 2009, National Institute for Health and Clinical Excellence.

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