Essential requirements for practice guidelines at national and local levels.

We explored whether local practice guidelines (PGs) on stroke management had undergone a process of local adaptation in relation to the appropriate and feasible configuration of stroke units (SUs). We critically appraised 7 PGs developed by 6 Italian local healthcare units, using explicit criteria to evaluate internal validity and their adequacy relative to local implementation issues. All PGs were developed by multidisciplinary working groups. In 4 of 6 PGs recommending SUs for stroke care, methodology for evidence retrieval was poor. Although organisational aspects were addressed in 4 of 6 PGs, details on how a SU should be organised were not provided in any of the examined PGs. Despite availability of national and international stroke PGs, at local level guidelines developers seem to spend time in "reinventing the wheel" rather than concentrating on what matters for local implementation. Besides being inefficient, this seems to lead to methodologically poor products inappropriate for what should be done to assure that interventions that work are packaged in a way that is compatible with their uptake into the ongoing services activities.