Deans' stroke musings: Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, May 14, 2019

Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials

If you actually want to solve this problem rather than talk about it, it is incredibly simple. Get these guidelines into protocols and make them publicly available in a database. The 10 million yearly stroke survivors would instantly DEMAND their stroke medical professionals use them to recover. But that won't happen, the medical professionals want to control shit that they refuse to implement for the best interests of their patients. I'd like an answer as to why this wouldn't work from our stroke teams. Top down isn't working, bottom up would get it distributed almost instantly. When the fuck are you going to realize guidelines are ineffective and not measurable?

Your doctor would no longer be in control. Too bad, so sad.

Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials

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Marie-Louise Bird

, Tiev Miller, Louise A Connell, ...

First Published May 8, 2019 Research Article

Abstract

Objective:

The aim of this study was to investigate the effectiveness of interventions aimed at moving research evidence into stroke rehabilitation practice through changing the practice of clinicians.

Data sources:

EMBASE, CINAHL, Cochrane and MEDLINE databases were searched from 1980 to April 2019. International trial registries and reference lists of included studies completed our search.

Review methods:

Randomized controlled trials that involved interventions aiming to change the practice of clinicians working in stroke rehabilitation were included. Bias was evaluated using RevMan to generate a risk of bias table. Evidence quality was evaluated using GRADE criteria.

Results:

A total of 16 trials were included (250 sites, 14,689 patients), evaluating a range of interventions including facilitation, audit and feedback, education and reminders. Of which, 11 studies included multicomponent interventions (using a combination of interventions). Four used educational interventions alone, and one used electronic reminders. Risk of bias was generally low. Overall, the GRADE criteria indicated that this body of literature was of low quality. This review found higher efficacy of trials which targeted fewer outcomes. Subgroup analysis indicated moderate-level GRADE evidence (103 sites, 10,877 patients) that trials which included both site facilitation and tailoring for local factors were effective in changing clinical practice. The effect size of these varied (odds ratio: 1.63–4.9). Education interventions alone were not effective.

Conclusion:

A large range of interventions are used to facilitate clinical practice change. Education is commonly used, but in isolation is not effective. Multicomponent interventions including facilitation and tailoring to local settings can change clinical practice and are more effective when targeting fewer changes.

Keywords ‘Change in clinical practice’, clinician behaviour, clinical practice guidelines, knowledge translation, patient outcomes, rehabilitation, stroke