Overview of Cochrane Systematic Reviews as a methodological tool to introduce Cochrane evidence in WHO guidelines: the Cochrane Rehabilitation experience

Background. The World Health Organization (WHO), following its “Rehabilitation 2030: a call for action”, launched a process to develop the Package of Rehabilitation Intervention (PRI), a minimum set to be proposed to all Health Ministries to achieve Universal Health Coverage, a WHO strategic priority. Cochrane Rehabilitation has been involved in developing the methodology of the PRI, and in providing the relevant Cochrane Evidence. Overviews of systematic reviews are a new methodology to synthesise the results of multiple systematic reviews. Since PRI is produced for different health intervention, overviews of Cochrane Systematic Reviews are a good tool to introduce Cochrane Evidence in the PRI. Objectives. The aim is to present the methodology developed to answer to the requests of WHO in the development of PRI. Methods. The main health condition studied has been stroke. The literature search used was the “tagging process” of Cochrane Rehabilitation as reported by Levack et al (Arch Phys Med Rehabil, 2019). The search was limited to the last 10 years. The reviewers collected for each CSR author, publication year, title, date of search, n° of included studies (n° of participants), population, setting, intervention, control, outcome, corresponding risk (95% CI), relative effect (95% CI), quality of evidence (GRADE), statistical method, heterogeneity, upgrade or downgrade motivation. Where not available in the original CSR, the Table of Findings with GRADE evaluation has been performed. Results. We found 62 CSRs (to September 2018): 33 had GRADE evaluation and 29 did not. The study is still ongoing: final results will be provided to the WHO in April 2019 and will be reported at the Colloquium. Conclusions. This study will provide recommendations on stroke rehabilitation, for different outcomes, based on Cochrane Evidence. Patient or healthcare consumer involvement. Not applicable. Relevance to diversity. The research addressed to rehabilitation stakeholders. The recommendations on stroke rehabilitation are important for all rehabilitation stakeholders to use better evidence that inform clinical and public health decisions.