Mv. Johnston et al., Rehabilitative placement of poststroke patients: Reliability of the Clinical Practice Guideline of the Agency for Health Care Policy and Research, ARCH PHYS M, 81(5), 2000, pp. 539-548
Objective: To determine the interrater reliability of the United States Age
ncy for Health Care Policy and Research (AHCPR) Clinical Practice Guideline
Number 16 for rehabilitative placement of poststroke patients.
Design: Pairs of rehabilitation professionals, highly trained in the Guidel
ine, rated the appropriateness of rehabilitative placements.
Setting: Acute care hospitals in three regions of the country.
Patients: Sixty patients with moderate-to-severe stroke.
Measures: Numerous factors affecting appropriate placement according to the
Guideline were abstracted from medical records or obtained by direct evalu
ation of patients.
Results: Good reliability was attained for home and nursing facility placem
ent with rehabilitation services but with no multidisciplinary rehabilitati
on program (intraclass correlation coefficient =.73 and .60, respectively).
Serious reliability problems were found for placements in low-intensity ou
tpatient rehabilitation and high-intensity inpatient rehabilitation program
s. Chief sources of unreliability were ambiguous or missing data in hospita
l medical records, complexities in the Guideline. and raters' tendencies to
follow their own clinical judgments. More than one type of placement was a
ppropriate for 65% of patients.
Conclusions: Reliable placement guidelines are possible, but aspects of the
Guideline require additional development. Evidence of demonstrated reliabi
lity and validity will be required to resolve disputes between rehabilitati
on professionals and payers regarding appropriate levels and types of rehab
ilitation and to guide patients and their families.