Beyond the Rct - Understanding the Relationship Between Interventions, Individuals and Outcome - the Example of Neurological Rehabilitation

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dc.contributor.authorKersten, P
dc.contributor.authorEllis-Hill, C
dc.contributor.authorMcPherson, KM
dc.contributor.authorHarrington, R
dc.date.accessioned2011-12-09T03:22:25Z
dc.date.available2011-12-09T03:22:25Z
dc.date.copyright2010
dc.date.issued2010
dc.description.abstractBackground Rehabilitation is highly complex, involving multiple processes, outcomes, and stakeholders. The way we deliver our services and work with our clients and their families, should be informed by research approaches that produce the wide range of knowledge needed. This paper aims to explore the degree to which the dominant approach to ‘evidence’ (the randomised clinical trial or RCT) meets those needs and discuss alternate/additional ways of gaining evidence. Methods A critical review of the literature allowing exploration of problems encountered in rehabilitation RCTs and alterative approaches. Findings We discuss some problematic issues related to using RCTs in rehabilitation research (for example the large number of people excluded from trials, and the small numbers of people with some neurological conditions making RCTs non viable). Alternative approaches are discussed including Clinical Practice Improvement studies (sometimes called Practice Based Evidence or PBE), which provide data on patients treated in routine practice; qualitative research, which can provide an understanding of the users of health care services to ensure they are meeting their needs; and metasynthesis, which can be used to summarise several qualitative studies to enhance our understanding of the principles underlying service delivery. Finally we explore how clinicians and commissioners often use evidence generated by forms of research other than the RCT. Conclusion 2 The best answers about how to enhance rehabilitation outcomes are likely to come from a combination and integration of the most appropriate methods. In conclusion, we urge for more joined up thinking, for learning from different fields so that we can develop more effective and appropriate health care and rehabilitation.
dc.identifier.citationDisability and Rehabilitation, vol.32(12), pp.1028 - 1034
dc.identifier.doi10.3109/09638281003775568
dc.identifier.issn0963-8288 (print) 1464-5165 (online)
dc.identifier.roid15810en_NZ
dc.identifier.urihttps://hdl.handle.net/10292/3058
dc.publisherInforma Healthcare Ltd.
dc.relation.urihttp://dx.doi.org/10.3109/09638281003775568
dc.rightsCopyright © Informa Healthcare, 2010. Authors retain the right to place his/her post-publication version of the work on a personal website or institutional repository for non commercial purposes. The definitive version was published in (see Citation). The original publication is available at (see Publisher's Version)
dc.rights.accessrightsOpenAccess
dc.subjectRehabilitation
dc.subjectRehabilitation medicine
dc.subjectPhysiotherapy
dc.subjectOccupational therapy
dc.subjectSpeech and language therapy
dc.subjectClinical psychology
dc.subjectRehabilitation nursing
dc.subjectEvidence-based medicine
dc.subjectPoststroke-rehabilitation
dc.subjectCochrane collaboration
dc.subjectClinical-practice
dc.subjectBlack-box
dc.subjectStroke
dc.subjectGuidelines
dc.subjectTherapy
dc.subjectTrials
dc.subjectPolicy
dc.titleBeyond the Rct - Understanding the Relationship Between Interventions, Individuals and Outcome - the Example of Neurological Rehabilitation
dc.typeJournal Article
pubs.organisational-data/AUT
pubs.organisational-data/AUT/Health & Environmental Science
pubs.organisational-data/AUT/PBRF Researchers
pubs.organisational-data/AUT/PBRF Researchers/Health & Environmental Sciences PBRF Researchers
pubs.organisational-data/AUT/PBRF Researchers/Health & Environmental Sciences PBRF Researchers/HES R & O Research
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