Translating evidence into stroke rehabilitation practice: Are interventions to promote the implementation of evidence-based practice effective?

Knowledge translation of scientific evidence into rehabilitation practice is a complex and yet largely unexplored topic. Potential issues identified as barriers to change may include economic, organizational, cultural, and psychological factors, as well as ineffective/delayed diffusion of evidence-based knowledge among healthcare professionals and organizations. As for stroke rehabilitation, despite the rapidly growing amount of high-quality research and evidence-based (EB) guidelines, changes in rehabilitation practice are not keeping up; as a result, most stroke patients worldwide do not receive rehabilitation based on the best available evidence. To promote implementation of EB rehabilitation, some strategies such as workshops, educational materials, and feedback to healthcare professionals about their performance are being developed and carried out. 

In 2020, Liana S. Cahill and other authors published a Cochrane review to assess whether interventions aimed at promoting the uptake of evidence-based practice in stroke rehabilitation may affect healthcare professional and/or patient adherence to recommended treatment, patient health status and well-being, healthcare professional intention and satisfaction, economic outcomes, and adverse effects. The authors also aimed to compare the effects of tailored vs non-tailored interventions to address identified barriers to change.  

Only nine trials (12,428 patient participants) and three ongoing trials met the authors’ selection criteria. The included trials explored either the acute, subacute, or community rehabilitation setting.

Most interventions were multifaceted, including educational meetings and educational materials; six trials assessed the effects of interventions tailored to address specific barriers. 

Authors concluded that no reliable estimate could be obtained of the effect of implementation intervention on healthcare professional adherence to evidence-based stroke rehabilitation practice, because of very low-quality evidence. Further, these strategies provide little or no difference in patient health-related quality of life (moderate-certainty evidence) and little or no difference in patient adherence to recommended treatment and psychological well-being (low-certainty evidence). No study reported the effects on healthcare professional intention-to-change behavior or satisfaction. Finally, the cost-effectiveness of interventions was not demonstrated, nor did tailoring interventions to identified barriers alter either clinical or economic results.  

In conclusion, to date, knowledge is still lacking about how best to promote evidence-based practices in stroke rehabilitation. Since, as the authors point out: “The full potential of stroke rehabilitation will only be realized through the sustained implementation of research knowledge into clinical practice,” future research attention and capital should be directed to increase the number and quality of studies addressing this topic.  

Comment by Francesca Cecchi