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

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Bird, ML ORCID: 0000-0001-9642-7196, Miller, T, Connell, LA and Eng, JJ 2019 , 'Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials' , Clinical Rehabilitation, vol. 33, no. 10 , pp. 1586-1595 , doi: 10.1177/0269215519847253.

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Abstract

Objective: The aim of this study was to investigate the effectiveness of interventions aimed at movingresearch evidence into stroke rehabilitation practice through changing the practice of clinicians.Data sources: EMBASE, CINAHL, Cochrane and MEDLINE databases were searched from 1980 toApril 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 practiceof clinicians working in stroke rehabilitation were included. Bias was evaluated using RevMan to generatea 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 interventionsincluding facilitation, audit and feedback, education and reminders. Of which, 11 studies includedmulticomponent interventions (using a combination of interventions). Four used educational interventionsalone, and one used electronic reminders. Risk of bias was generally low. Overall, the GRADE criteriaindicated that this body of literature was of low quality. This review found higher efficacy of trials whichtargeted fewer outcomes. Subgroup analysis indicated moderate-level GRADE evidence (103 sites, 10,877patients) that trials which included both site facilitation and tailoring for local factors were effective inchanging clinical practice. The effect size of these varied (odds ratio: 1.63–4.9). Education interventionsalone were not effective.Conclusion: A large range of interventions are used to facilitate clinical practice change. Education iscommonly used, but in isolation is not effective. Multicomponent interventions including facilitation andtailoring to local settings can change clinical practice and are more effective when targeting fewer changes.

Item Type: Article
Authors/Creators:Bird, ML and Miller, T and Connell, LA and Eng, JJ
Keywords: ‘Change in clinical practice’, clinician behaviour, clinical practice guidelines, knowledge translation, patient outcomes, rehabilitation, stroke
Journal or Publication Title: Clinical Rehabilitation
Publisher: Arnold
ISSN: 0269-2155
DOI / ID Number: 10.1177/0269215519847253
Copyright Information:

© The Author(s) 2019

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