Beyond the RCT understanding the relationship between interventions, individuals and outcome the example of neurological rehabilitation

Authors: Kersten, P., Ellis-Hill, C., McPherson, K.M. and Harrington, R.

Journal: Disability and Rehabilitation

Volume: 32

Issue: 12

Pages: 1028-1034

eISSN: 1464-5165

ISSN: 0963-8288

DOI: 10.3109/09638281003775568

Abstract:

Background. 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 article 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. 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.

Source: Scopus

Beyond the RCT - understanding the relationship between interventions, individuals and outcome - the example of neurological rehabilitation.

Authors: Kersten, P., Ellis-Hill, C., McPherson, K.M. and Harrington, R.

Journal: Disabil Rehabil

Volume: 32

Issue: 12

Pages: 1028-1034

ISSN: 0963-8288

DOI: 10.3109/09638281003775568

Abstract:

BACKGROUND: 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 article 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: 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.

Source: PubMed

Beyond the RCT - understanding the relationship between interventions, individuals and outcome - the example of neurological rehabilitation

Authors: Kersten, P., Ellis-Hill, C., McPherson, K.M. and Harrington, R.

Journal: DISABILITY AND REHABILITATION

Volume: 32

Issue: 12

Pages: 1028-1034

eISSN: 1464-5165

ISSN: 0963-8288

DOI: 10.3109/09638281003775568

Source: Web of Science (Lite)

Beyond the RCT – understanding the relationship between interventions, individuals and outcome – the example of neurological rehabilitation

Authors: Kersten, P., Ellis-Hill, C., McPherson, K.M. and Harrington, R.

Journal: Disability & Rehabilitation

Volume: 32

Pages: 1028-1034

ISSN: 0963-8288

DOI: 10.3109/09638281003775568

Abstract:

Background.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 article 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.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.

http://dx.doi.org/10.3109/09638281003775568

Source: Manual

Preferred by: Caroline Ellis-Hill and Paula Kersten

Beyond the RCT - understanding the relationship between interventions, individuals and outcome - the example of neurological rehabilitation.

Authors: Kersten, P., Ellis-Hill, C., McPherson, K.M. and Harrington, R.

Journal: Disability and rehabilitation

Volume: 32

Issue: 12

Pages: 1028-1034

eISSN: 1464-5165

ISSN: 0963-8288

DOI: 10.3109/09638281003775568

Abstract:

Background

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 article 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

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.

Source: Europe PubMed Central