A systematic review is a way to summarise the best available research evidence on the effectiveness of healthcare interventions for patients, family members and healthcare professionals. As the leading resource for systematic reviews in healthcare, high standards are expected of contributors to the Cochrane Database of Systematic Reviews. We were therefore delighted to hear that, in the field of stroke, the top three most accessed Cochrane reviews of 2015 were led by Unit researchers. These reviews of interventions to improve arm function, mobility and communication also made it into the top 50 most cited Cochrane reviews from the whole Cochrane Library, which has over 17,000 reviews. Reacting to the news, the Unit’s Alex Pollock said, “We are all motivated by a passion for improving the lives of people who have had a stroke. The access statistics for these reviews suggests that our efforts to identify best evidence are informing the practice of rehabilitation professionals including occupational, physio and speech and language therapists.”
Alex, Sybil Farmer and Marian Brady led the overview ‘Interventions for improving upper limb function after stroke’. By identifying more than 74 systematic reviews useful to clinicians and policymakers, they provided one accessible, comprehensive document to support decision making. However, they noted that the evidence for interventions used routinely in practice is insufficient and that more than half of people with impairments to their arm following a stroke still have problems many months or years later. This means there is an urgent need for high quality research of the most promising interventions.
Alex was again involved with the second most accessed stroke review ‘Physical rehabilitation approaches for the recovery of function and mobility following stroke’, with colleagues this time including Pauline Campbell and Jacqui Morris. Their review suggested that physiotherapy which comprises well-chosen components from different approaches selected to suit an individual patient is more effective than physiotherapy confined to a single, named approach.
Arian led the third most accessed stroke review
, ‘Speech and language therapy for aphasia following stroke’, with Pauline also lending her expertise. This review concluded that speech and language therapy is effective compared with no therapy for improving communication, reading, writing and expressive language in people with aphasia, and that, for people in the early months after stroke, more therapy over a shorter period may be more beneficial than less intensive models.
Unit staff have amassed considerable experience in reviewing complex rehabilitation interventions, and are making methodological advances (such as the MASK project
with the University of Edinburgh). As a consequence, Alex and Cochrane co-authors at Glasgow Caledonian University are in discussion with the International Journal of Stroke
about a paper on systematic reviews. Alex has also just attended, by invitation, an exploratory meeting in Italy relating to a proposed new Cochrane field focused on rehabilitation reviews. Hosted by the University of Brescia, it was attended by international experts in evidence based rehabilitation from 19 countries.