http://www.bmj.com/content/345/bmj.e4870?view=long&pmid=22807163
Research
into rehabilitation is a relatively young discipline and there are
still few centres of academic excellence in stroke rehabilitation.
Randomised trials are difficult to conduct in this area. Large
variations in patients and disease characteristics make designing trials
tricky(So What); blinding may be difficult; and identifying appropriate control
interventions and ensuring that interventions are standardised,
especially in multi-site studies, is challenging. However, such problems
are not unique to rehabilitation research and can be overcome using
complex intervention evaluation methods, as has been shown in other
areas of stroke care.1 In a linked
research paper (doi:10.1136/bmj.e4407), Bowen and colleagues report the
findings of the ACT NoW (Assessing Communication Therapy in the North
West) study, which is a large scale multicentre randomised controlled
trial of speech and language therapy in the rehabilitation of patients
after stroke.2 This study is welcome
because, as with other treatment interventions, it is essential that
rehabilitation is subjected to rigorous scrutiny.
Single
case studies, observational studies, and small single centre randomised
trials provide weak evidence for guiding clinicians and planners of
care, and they cannot answer fundamental questions about how and what
services should …
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