Improving the quality of evidence production in rehabilitation. Results of the 5th Cochrane Rehabilitation Methodological Meeting

Abstract

The paper introduces the Special Sections of the European Journal of Physical and Rehabilitation Medicine dedicated to the 5 th Methodological Meeting of Cochrane Rehabilitation. It introduces Cochrane Rehabilitation; its vision, mission and goals; discusses why the Methodological Meetings were created; and reports on their organisation and previous outcomes. The core content of this editorial is the 5 th Methodological Meeting held in Milan in September 2023. The original title for this meeting was “The Rehabilitation Evidence Ecosystem: useful study designs.” The focus of the Milan meeting was informed by the lessons learned by Cochrane Rehabilitation in the past few years, by the new rehabilitation definition for research purposes, by the collaboration with the World Health Organization (WHO), and by the REH-COVER (Rehabilitation COVID-19 Evidence-Based Response) action. During the Meeting, participants discussed the current methodological evidence on the following: RCTs in rehabilitation coming from meta-epidemiological studies; observational study designs – specifically the IDEAL Framework (Idea, Development, Exploration, Assessment, Long-term study) and its potential implementation in rehabilitation and the Target Trial Emulation framework: Single Case Experimental Designs; complex intervention studies: health services research studies, and studies using qualitative approaches. The Meeting culminated in the development of a first version of a “road map” to navigate the evidence production in rehabilitation according to the previous discussions. The Special Sections’ papers present all topics discussed at the meeting, and a methodological paper about choosing the right research question, presenting final results and the “road map” for evidence production in rehabilitation.

Introduction to target trial emulation in rehabilitation: a systematic approach to emulate a randomized controlled trial using observational data

“…However, randomization is indicated under specific circumstances: 1) when clinical equipoise is present; 8 2) when the interventions being tested do not exceed accepted minimal risks; 3) when it is acceptable to patients; or 4) previous research justifies its conduct. 9 …”

“…Nonetheless, evidence is strongly needed and strategies with alternative study designs can overcome these challenges. Finally, as described by Shearer et al ., 9 testing the effectiveness of rehabilitation in an RCT requires that preliminary research supports its feasibility, potential benefits, and safety for patients.…”

“…According to Cochrane Rehabilitation, rehabilitation includes a multimodal, person-centered, and collaborative process, that targets a person’s capacity or contextual factors related to performance with the goal of optimizing functioning. 9 , 11 Rehabilitation is inherently complex and needs to be tailored to an individual’s needs. The complexity of rehabilitation resides in its structure, delivery mode and targeted outcomes, while its design requires combining clinical interventions and technologies, clinicians, settings, and recipients of the intervention (patients, family, and community).…”