Cochrane Systematic Review - Enabling Evidence-Based Physiotherapy after Stroke

Mehrholz J.^1,2, Pollock A.³, Moseley A.⁴, States R.⁵

¹Klinik Bavaria, Wissenschaftliches Institut, Kreischa, Germany, ²SRH FH Gera, Lehrstuhl Therapiewissenschaften, Gera, Germany, ³Glasgow Caledonian University, Nursing Midwifery and Allied Health Professions Research Unit, Glasgow, United Kingdom, ⁴The George Institute for International Health, Sydney, Australia, ⁵Long Island University, Brooklyn Campus, Physical Therapy, New York, United States of America

Learning objectives:

1. To be familiar with the work of the Cochrane Collaboration and with Cochrane systematic reviews 2. To recognise the relevance of Cochrane systematic reviews to clinical physiotherapy practice, and to know where there currently is evidence relating to physiotherapy for instance for physiotherapy after stroke 3. To have a detailed understanding of the implications of three key Cochrane systematic reviews to stroke physiotherapy practice .

Description:

This symposium will focus on the use of Cochrane systematic reviews to facilitate the delivery of evidence-based stroke physiotherapy practice.

The Cochrane Collaboration is an international not for profit organisation that aims to help people make well-informed decisions about healthcare by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of health care interventions. The Cochrane Stroke Group is a Cochrane Collaborative review group and provides systematic reviews relating to stroke prevention, treatment and rehabilitation with more than 340 reviewers from more than 22 countries. The Cochrane Stroke Group trials register has listed far more than 12,000 references to more than 5,000 trials and has published more than 100 completed systematic reviews.

Cochrane systematic reviews aim to provide a reliable source that summarises the best evidence on the effects of a particular healthcare intervention at a particular point in time. Cochrane reviews have been recognised as providing the highest quality healthcare evidence. Systematic reviews of complex interventions, such as hands-on physiotherapy treatments, have a number of methodological challenges. There is evidence to suggest that Cochrane reviews of physiotherapy interventions use more rigorous methods than non-Cochrane reviews, and that the Cochrane reviews are less prone to bias. The results of Cochrane systematic reviews therefore have important implications for patients, carers, practitioners, educators, managers and policy-makers with an interest in evidence-based stroke physiotherapy.

There are approximately 30 completed Cochrane systematic reviews directly relevant to stroke physiotherapy and a further approximately 30 Cochrane systematic reviews relevant to the wider field of stroke rehabilitation. These reviews cover a wide range of physiotherapy and rehabilitation interventions, such as acupuncture, electrostimulation, biofeedback, physiotherapy treatment approaches, treadmill training, electromechanical-assisted walking, robot and electromechanical devices for arm function. Detailed overviews of three key Cochrane systematic reviews will be delivered, and the clinical implications of these reviews discussed. For example people with stroke remain often dependent in walking or needs assistance when walking is achieved. A Cochrane review of electromechanical and robot-assisted therapy has demonstrated that if electromechanical devices are used in gait rehabilitation, one of six people with stroke would now be able to walk alone again.

Implications / Conclusions:

Cochrane systematic reviews are tools designed to enable physiotherapists to deliver the best possible treatment for an individual patient, taking into account factors such as the physiotherapist's expertise, health-care setting, and the personal preferences of the patient. There is a large and growing body of Cochrane review evidence relevant to physiotherapy after stroke. It is essential that all physiotherapy practitioners, researchers, educators, managers and policy-makers aiming to achieve evidence-based stroke physiotherapy are familiar with, and use, the results of these reviews.

Keywords:

Evidence; Stroke; Systematic reviews

Funding acknowledgements:

Dr Alex Pollock is employed by the Nursing Midwifery and Allied Health Professions Research Unit which is funded by the Scottish Government’s Chief Scientist’s Office.

Relevance to WCPT and expected audience:

This focused symposia will present an overview of Cochrane reviews relevant to physiotherapists and practitioners, managers and policy makers working in the field of stroke care, discuss the advantages of Cochrane review methods, and provide evidence-based clinical implications from key Cochrane reviews related to physiotherapy for patients with stroke. This symposium will therefore provide an excellent opportunity to present and discuss systematic reviews of high quality research evidence and the implications for physiotherapy practice.

Target audience:

• Physiotherapists working with stroke patients
• Practitioners, researchers, educators, managers and/or policy-makers with an interest in evidence-based physiotherapy, evidence-based stroke rehabilitation and/or systematic reviews.

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