Rehabilitation for post-stroke cognitive impairment: an overview of recommendations arising from systematic reviews of current evidence

Well these lazy bastards, in the last paragraph they throw up their hands in defeat.
Why not try these? Are you that incompetent that you don't keep up and read current research?
Are you waiting for someone else to propose something? All the while your stroke patients are not getting better. Current standard of care for stroke is a complete failure yet no one wants to create something new.

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 http://cre.sagepub.com/content/early/2014/06/18/0269215514538982.abstract

1. David C Gillespie1
2. Audrey Bowen2
3. Charlie S Chung3
4. Janet Cockburn4
5. Peter Knapp5
6. Alex Pollock6

1. ¹Clinical Neuropsychology Service, Western General Hospital, Edinburgh, UK
2. ²Stroke Research, University of Manchester, Manchester, UK
3. ³Department of Occupational Therapy, NHS Fife, Fife, UK
4. ⁴Retired, UK
5. ⁵Department of Health Sciences, University of York, York, UK
6. ⁶Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK

1. David C Gillespie, Clinical Neuropsychology Service, Department of Clinical Neurosciences (DCN), Western General Hospital, Edinburgh EH4 2XU, UK. Email: david.gillespie@nhslothian.scot.nhs.uk

Abstract

Background: Although cognitive impairments are common following stroke, there is considerable uncertainty about the types of interventions that can reduce activity restrictions and improve quality of life. Indeed, a recent project to identify priorities for research into life after stroke determined that the top priority for patients, carers and health professionals was how to improve cognitive impairments.

Objective: To provide an overview of the evidence for the effectiveness of cognitive rehabilitation for patients with stroke and to determine the main gaps in the current evidence base.

Methods: Evidence was synthesised for the six Cochrane reviews relating to rehabilitation for post-stroke cognitive impairment and any subsequently published randomized controlled trials to February 2012.

Results: Data arising from 44 trials involving over 1500 patients was identified. Though there was support for the effectiveness of cognitive rehabilitation for some cognitive impairments, significant gaps were found in the current evidence base. All of the Cochrane reviews identified major limitations within the evidence they identified.

Conclusions: There is currently insufficient research evidence, or evidence of insufficient quality, to support clear recommendations for clinical practice. Recommendations are made as to the research required to strengthen the evidence base, and so facilitate the delivery of effective interventions to individuals with cognitive impairment after stroke.