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


Bird, ML and Miller, T and Connell, LA and Eng, JJ, Moving stroke rehabilitation evidence into practice: a systematic review of randomized controlled trials, Clinical Rehabilitation, 33, (10) pp. 1586-1595. ISSN 0269-2155 (2019) [Refereed Article]

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© The Author(s) 2019

DOI: doi:10.1177/0269215519847253


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.

Item Details

Item Type:Refereed Article
Keywords:‘Change in clinical practice’, clinician behaviour, clinical practice guidelines, knowledge translation, patient outcomes, rehabilitation, stroke
Research Division:Biomedical and Clinical Sciences
Research Group:Neurosciences
Research Field:Central nervous system
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Preventive medicine
UTAS Author:Bird, ML (Dr Marie-Louise Bird)
ID Code:135991
Year Published:2019
Web of Science® Times Cited:8
Deposited By:Health Sciences
Deposited On:2019-11-25
Last Modified:2019-12-06
Downloads:5 View Download Statistics

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