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

https://doi.org/10.1177/0269215519847253

Article information

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

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'Plateau' in progress on heart disease, stroke deaths

What the hell is your strategy to solve and reverse that problem in stroke? Hopefully it is to look at all the 30 day deaths and solve them. NOT by lazily putting out more prevention press releases. Damn it all, do the hard work to solve stroke. NOT just waiting for SOMEONE ELSE TO SOLVE THE PROBLEM?

1.  Describe the problem exactly. 
2.  Write an RFP to researchers to solve that problem.
3.  Fund them with foundation grants.
4.  Write stroke rehab protocols based on the research.
5.  Get the Nobel prize in medicine  

'Plateau' in progress on heart disease, stroke deaths

The rate of deaths from heart disease barely decreased last year while deaths from stroke increased slightly, and life expectancy continued to slip in the U.S., according to federal statistics released Thursday.
The annual report on mortality from the Centers for Disease Control and Prevention found that heart disease killed 647,457 people in 2017, more than any other cause. The rate was 165 deaths per 100,000 people, a slight drop from 165.5 the year before.
Deaths from stroke on the other hand, the fifth-leading cause, increased 0.8 percent between 2016 and 2017. There were 146,383 stroke deaths in 2017, or a rate of 37.6 per 100,000 people.
Last year, the CDC issued a report warning that a decades-long decrease in stroke death rates had "slowed, stalled, or in some cases, reversed in recent years."
"This plateau in our progress to reduce heart disease and stroke deaths is disappointing, and we know there is much work to still be done," said Dr. Ivor J. Benjamin, president of the American Heart Association. "As we continue to see more scientific evidence supporting links between cardiovascular disease risk factors and so many other conditions, we are expanding our work in new directions that could have a profound impact on multiple fronts of our lifesaving mission."
The AHA is investing millions into areas related to brain health, such as Alzheimer's disease, and diabetes, a major risk factor for heart disease, said Benjamin, director of the Cardiovascular Center at the Medical College of Wisconsin.(Not one thing mentioned here has any specific measurable responsibility to solve all the problems in stroke. You fucking lazy bastards.)
Research shows people living with diabetes are at least two times more likely to develop and die from cardiovascular disease. Numerous studies also have linked brain and heart health.
"The more we learn about the fundamental causes of all deaths, we see so many connections that come back to the same risk factors that lead to heart disease and stroke," Benjamin said.
The CDC report showed Alzheimer's disease is the No. 6 cause of death, just behind stroke, and diabetes ranks seventh. The data tracked a 2.4 percent rise in diabetes-related deaths, from 80,058 in 2016 to 83,564 in 2017. Alzheimer's disease deaths rose 2.3 percent, from 116,103 to 121,404.
Here are other highlights from the CDC's National Center for Health Statistics report:

• The 10 leading causes of death, in order, are heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, Alzheimer's disease, diabetes, flu and pneumonia, kidney disease, and suicide.

• Life expectancy decreased by slightly more than a month, to 78.6 years in 2017, largely because of increases in mortality from unintentional injuries, suicide, diabetes, and flu and pneumonia. The life expectancy decline follows a trend in recent years, with rates continuing to drop slightly since the 2015 rate of 78.8 years. "Life expectancy gives us a snapshot of the nation's overall health," CDC director Dr. Robert R. Redfield said in a statement, "and these sobering statistics are a wake-up call that we are losing too many Americans, too early and too often, to conditions that are preventable."

• Overall, men fared worse than women when it came to life expectancy. For men, life expectancy dropped from 76.2 to 76.1 years in 2017, while life expectancy for women stayed the same at 81.1 years.

• Drug overdose deaths rose by 9.6 percent, with the majority listed as unintentional. The report said 70,237 Americans died from drug overdoses in 2017 – or 21.7 deaths per 100,000 people. Synthetic opioids, including fentanyl, were the biggest factor, the report said.

• Flu and pneumonia claimed 5.9 percent more people, rising from 51,537 deaths in 2016 to 55,672 in 2017.

• Suicide deaths increased by 3.7 percent, from 44,965 in 2016 to 47,173 in 2017. Suicide rates in the U.S. have increased since 1999 for both men and women, and rates in the most rural U.S. counties are nearly twice as high as rates in the country's most urban counties.

If you have questions or comments about this story, please email editor@heart.org.

• Commentary from Christina M. Shay, director of Impact and Health Metrics at the American Heart Association: "US Life Expectancy Drops for Third Year in a Row – What We Know and Don’t Know From the 2017 CDC Mortality Report"

You can't improve what you can't measure

It comes from a remark attributed to GALILEO, who said 'Count what is
countable, measure what is measurable. What is not measurable, make
measurable'."
Boy does this describe the brain and stroke effects and rehabilitation. We don't know exactly how neuroplasticity works so we can't figure out how to consistently duplicate it. This is where we hear the canard, ' All strokes are different, all stroke recoveries are different' If we can't measure the recovery we can't improve it.