Methodological difificulties in rehabilitation research

Abstract

This paper presents an overview of some of the pitfalls and suggests ways of improving the quality of research into rehabilitation after stroke. The aims of rehabilitation are outlined and methodological problems inherent in this area discussed, including spontaneous recovery, multidimensional outcomes, definition of treatment and placebo effects. Major weaknesses found in the rehabilitation literature are identified and recommendations for improvement made, including the need for comparable controls, adequate numbers, appropriate outcome measures, clear definition of therapy, generalizability, and a concern for the cost-effectiveness of stroke rehabilitation packages. The field of rehabilitation is still relatively new and idiosyncratic in form and content. Thus it still provides opportunities for research into its relative effectiveness before current practices in rehabilitation become entrenched in medical practice and folklore. Adequate funding support for improved, multicentre clinical trials in rehabilitation is essential.

Cost-benefits associated with social outcome from neurobehavioural rehabilitation

“…Despite the methodological difficulties attached to rehabilitation research [7,8], many meta-reviews carried out subsequently have concluded that rehabilitation brings about significant gains in terms of personal autonomy and the ability to return home, return to work and participate in family and civic life [9][10][11]. Yet, in a healthcare climate of seemingly infinite demand and limited Correspondence: Dr Andrew D. Worthington, West Heath House, 54 Ivy House Road, West Heath, Birmingham B38 8JW, UK.…”

Effects of a stroke rehabilitation education programme for nurses

“…It has been suggested that stroke units reduce disability through an integrated programme of rehabilitation that allows therapeutic strategies to continue beyond formal therapy (Stroke Unit Trialists' Collaboration 1997a). However, the effect of informal therapy, such as that provided by nurses, is unclear since it is hard to quantify (Pollock et al 1993). While there is general recognition that the nursing contribution to the outcomes of stroke rehabilitation is important this has received little specific research attention.…”

Effectiveness of two rehabilitation strategies provided by nurses for stroke patients in Mexico

“…1997). However, despite accumulating evidence of numerous stroke rehabilitation strategies, there is no general consensus regarding the specific role of the nurse in rehabilitation and their impact on its continuity still is debated (Pollock et al. 1993, Forster & Young 1996, Burton 2003).…”

“…In many developed countries, stroke care has been radically changed following a Cochrane review (Stroke Unit Trialists' Collaboration 1997a,b) demonstrating that 'organised in-patient care' (stroke units) significantly improved mortality and morbidity poststroke (Indredavik et al 1997). However, despite accumulating evidence of numerous stroke rehabilitation strategies, there is no general consensus regarding the specific role of the nurse in rehabilitation and their impact on its continuity still is debated (Pollock et al 1993, Forster & Young 1996, Burton 2003.…”