Stroke Rehabilitation
Evidence behind stroke rehabilitation
Stroke is a common and serious condition for which there is no routinely available curative treatment. Because of the high burden of disability and the lack of a widely applicable medical treatment, much of post-stroke care relies upon rehabilitation interventions. This article will discuss the evidence behind stroke rehabilitation interventions. but before doing so we need to define some terminology. Rehabilitation has a rather non-specific definition: “a problem solving process aiming at reducing the disability and handicap resulting from a disease”. In this article we will use a broad definition of rehabilitation, which includes any general aspect of stroke care (generally non-surgical, non-pharmaceutical interventions) that aims to reduce disability and handicap (that is, promote activity and participation). This definition avoids an artificial splitting of early (often termed “acute”) and later (“rehabilitation”) care; rehabilitation interventions are relevant from the onset of symptoms. The main focus will be on evidence about treatments as these are the most common questions posed by clinicians.
CHALLENGES TO EVIDENCE BASED PRACTICE IN STROKE REHABILITATION
Conducting methodologically rigorous evaluations of rehabilitation interventions is complex. Firstly, rehabilitation interventions are traditionally tailored by a therapist or nurse to meet the identified needs of an individual patient. As such they can be difficult to define and test within a randomised trial. Secondly, a key strength of the randomised trial can be that both patients and health professionals are blind to the treatment given. In a circumstance where a therapist is applying a manual treatment technique to a patient it is often impossible to achieve such double blinding, although blinding of outcome assessment is usually possible (single blinding). Thirdly, many rehabilitation interventions are targeted at ameliorating a specific body function or
Stroke is a common and serious condition for which there is no routinely available curative treatment. Because of the high burden of disability and the lack of a widely applicable medical treatment, much of post-stroke care relies upon rehabilitation interventions. This article will discuss the evidence behind stroke rehabilitation interventions. but before doing so we need to define some terminology. Rehabilitation has a rather non-specific definition: “a problem solving process aiming at reducing the disability and handicap resulting from a disease”. In this article we will use a broad definition of rehabilitation, which includes any general aspect of stroke care (generally non-surgical, non-pharmaceutical interventions) that aims to reduce disability and handicap (that is, promote activity and participation). This definition avoids an artificial splitting of early (often termed “acute”) and later (“rehabilitation”) care; rehabilitation interventions are relevant from the onset of symptoms. The main focus will be on evidence about treatments as these are the most common questions posed by clinicians.
CHALLENGES TO EVIDENCE BASED PRACTICE IN STROKE REHABILITATION
Conducting methodologically rigorous evaluations of rehabilitation interventions is complex. Firstly, rehabilitation interventions are traditionally tailored by a therapist or nurse to meet the identified needs of an individual patient. As such they can be difficult to define and test within a randomised trial. Secondly, a key strength of the randomised trial can be that both patients and health professionals are blind to the treatment given. In a circumstance where a therapist is applying a manual treatment technique to a patient it is often impossible to achieve such double blinding, although blinding of outcome assessment is usually possible (single blinding). Thirdly, many rehabilitation interventions are targeted at ameliorating a specific body function or
References: 1. Warlow CP, Dennis MS, van Gijn J, et al. A problem based approach to the general management of stroke. In: Stroke: a practical guide to management. Oxford: Blackwell Science, 2001. 2. Sandercock P, Anderson C, Bath P, et al. Cochrane Stroke Group. In: Co-ordinating. The Cochrane Library. Issue 1. Oxford: Update Software, 2003. 3. Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care after stroke (Cochrane review). In: The Cochrane Library. Issue 2. Oxford: Update Software, 2003. 4. Langhorne P, Dennis MS. Stroke units: an evidence-based approach. London: BMJ Publishing Group, 1998.