A systematic review protocol for assessing equity in clinical practice guidelines for traumatic brain injury and homelessness

Abstract

BackgroundWhen used optimally, clinical practice guidelines (CPGs) can reduce inappropriate variations in practice, improve application of research to practice, and enhance the quality of healthcare. However, a common criticism, despite its potential, is the lack of consideration for equity and disadvantaged populations.ObjectivesThis protocol is for a systematic review of CPGs for traumatic brain injury (TBI) and homelessness that aims to assess (1) the extent to which evidence regarding TBI and homelessness is integrated in CPGs for homelessness and TBI, respectively, and (2) equity considerations in CPGs for TBI and homelessness.Methods and analysisThe methodology for this review is guided by the PRISMA-P, validated search filters for CPGs, and methodological guides to searching systematic reviews and gray literature. CPGs will be identified from (a) databases for peer-reviewed literature (MEDLINE, Embase, CINAHL, and PsycInfo), (b) targeted websites and Google Search for gray literature, and (c) reference lists of peer-reviewed and gray literature that meet the eligibility criteria. Searching for gray literature, including from guideline-specific resources, is a critical component of this review and is considered an efficient approach to identifying CPGs, given the low precision of searching peer-reviewed databases. Two independent reviewers will screen all articles based on pre-determined eligibility criteria. A narrative synthesis will be conducted to identify the proportion of CPGs that integrate evidence about TBI and homelessness and how TBI and homelessness is or is not integrated in CPGs. Quality appraisal will take the form of an equity assessment of CPGs and will be completed independently by two reviewers.ConclusionThis protocol outlines the methodology for a systematic review of CPGs for TBI and homelessness. The resulting systematic review from this protocol will form an evidence-based foundation to advance CPGs for individuals with lived experience of TBI and homelessness.Systematic review registrationidentifier: CRD42021287696.

Equity considerations in clinical practice guidelines for traumatic brain injury and homelessness: a systematic review

“…The protocol for this systematic review was published in a peer-reviewed journal. 14 To further increase replicability and transparency, we utilised a rigorous search strategy using validated search filters for CPGs 15 and methodological guides to grey literature searching. 20 In particular, the search for grey literature, is an important strength of this review, given the low precision of searching databases for peer-reviewed CPGs.…”

“…We followed the screening process outlined in our protocol. 14 For the search conducted in November 2021, the resulting agreement for title and abstract screening was 94.6% for English articles and 90.0% for non-English language articles. The resulting agreement for full-text screening was 95.4% for English articles and 94.9% for non-English language articles.…”

“…The protocol for this systematic review was published in a peer-reviewed journal 14 and registered on PROSPERO [CRD42021287696]. The reporting of this systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) extension for searching (PRISMA-S) and the PRISMA Equity Checklist.…”

“…We followed the screening process outlined in our protocol. 14 Microsoft Excel was used to document the study selection process, including the search date, the name and link of each website, and the reasons for exclusion at the full-text screening stage.…”

Exploring the Role of Rehabilitation Medicine Within an Inclusion Health Context: Examining a Population at Risk From Homelessness and Brain Injury in Edinburgh

“…Policy guidance regarding the health of people experiencing homelessness, is clear that identification of brain injury, and management of its sequelae should be priority areas in inclusion health efforts [2,18]. Despite this, a recent review looking at clinical practice guidelines for management of brain injury, found a majority of guidelines did not have any special provision for management of brain injury in people who are experiencing homelessness [22]. This study took advantage of the unique access to a local specialist 'access' primary care provider, specialising in people experiencing homelessness and vulnerably housed people, and a local 'in reach' inclusion health service which had a presence in local acute hospitals.…”