Guideline: Neurorehabilitation in patients with disorder of consciousness. Recommendations from the Spanish Society of Neurorehabilitation

Abstract

Introduction

Clinical practice guidelines in neurorehabilitation for adults with disorders of consciousness by the Spanish Neurorehabilitation Society. This document is based on a review of international clinical practice guidelines published between 2015 and 2022.

Method

A total of 7 articles, corresponding to 5 clinical practice guidelines published between 2015 and 2022, were selected by the group of authors from a pool of 48 bibliographic references extracted from various databases in accordance with predefined search criteria. Following this review, forty recommendations were formulated and subjected to evaluation by an expert committee using a 9-point Likert scale: 1–3 (inappropriate recommendation), 4–6 (uncertain recommendation), and 7–9 (appropriate recommendation), following the methodology of the “Modified Nominal Group Technique.” Any recommendation endorsed by at least 75% of the experts as “appropriate” (with a score of 7–9) was considered accepted.

Conclusions

This document presents 40 recommendations categorised according to the level of evidence provided by the reviewed studies. These recommendations represent a consensus among experts and pertain to various aspects related to: 1) clinical assessment, 2) complementary diagnostic tests, 3) prognosis, and 4) treatment in this specific population.