Moving Stroke Rehabilitation Research Evidence into Clinical Practice: Consensus-Based Core Recommendations From the Stroke Recovery and Rehabilitation Roundtable

Abstract

Moving research evidence to practice can take years, if not decades, which denies stroke patients and families from receiving the best care. We present the results of an international consensus process prioritizing what research evidence to implement into stroke rehabilitation practice to have maximal impact. An international 10-member Knowledge Translation Working Group collaborated over a six-month period via videoconferences and a two-day face-to-face meeting. The process was informed from surveys received from 112 consumers/family members and 502 health care providers in over 28 countries, as well as from an international advisory of 20 representatives from 13 countries. From this consensus process, five of the nine identified priorities relate to service delivery (interdisciplinary care, screening and assessment, clinical practice guidelines, intensity, family support) and are generally feasible to implement or improve upon today. Readily available website resources are identified to help health care providers harness the necessary means to implement existing knowledge and solutions to improve service delivery. The remaining four priorities relate to system issues (access to services, transitions in care) and resources (equipment/technology, staffing) and are acknowledged to be more difficult to implement. We recommend that health care providers, managers, and organizations determine whether the priorities we identified are gaps in their local practice, and if so, consider implementation solutions to address them to improve the quality of lives of people living with stroke.

Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives

“…Stroke Recovery and Rehabilitation Roundtables bring physiotherapists and other experts together to recommend research directions and produce guidance for the post-stroke healthcare system. Optimized delivery of stroke care systems and access to rehabilitation services are the future of healthcare for stroke [ 166 ].…”

What is the potential of virtual reality for post-stroke sensorimotor rehabilitation?

“…Constraints such as limited time, personnel, or resources, affect the amount of therapy that can be delivered in inpatient and outpatient rehabilitation settings. For example, Lang et al [5] found that patients in an outpatient stroke unit practiced an average of only 41 active and purposeful movement repetitions of the upper limb per session, far below the number needed for motor skill acquisition and the recommended dose according to national and international stroke rehabilitation guidelines [6]. To address this problem, VR training platforms may be used as adjunctive therapy in which opportunities for extended practice may be made available for patients with supervision in groups or with specialized support personnel [7].…”

“…For lower limb functions of balance and gait in patients with mostly post-acute stroke, de Rooij et al (18) found that virtual rehabilitation was more effective when added to conventional therapy and dose-matched for time in therapy, compared to conventional treatment alone. Thus, virtual rehabilitation as an adjunctive therapy has the benefit of increasing the amount of therapy delivered to the patient, which is linked to better outcomes, and has made its way into clinical practice guidelines for stroke care [6]. However, there is still a lack of evidence of the effectiveness of virtual reality applications for cognitive post-stroke rehabilitation and on participation and activities of daily living [17].…”

Facilitators and “deal breakers”: a mixed methods study investigating implementation of the Goal setting and action planning (G-AP) framework in community rehabilitation teams

“…Our findings, combined with evidence-based recommendations made in the aforementioned studies [41,48,49], will inform future enhancements to G-AP training and implementation strategies (see Table 7). This will be a focus of our ongoing research, the overall aim of which is to fully develop G-AP as a complex intervention (including training, supporting resources, implementation tools and strategies) ready for implementation and evaluation in a suitably designed large scale study.…”