62 Implementation: the missing link in the stroke rehabilitation research pipeline

Objectives Despite the exponential growth in the evidence base for stroke rehabilitation, there is still a paucity of knowledge about how to consistently and sustainably deliver evidence-based stroke rehabilitation therapies in clinical practice. This means that people with stroke will not consistently benefit from research breakthroughs, simply because clinicians do not always have the skills, authority, knowledge or resources to be able to translate the findings from a research trial and apply these in clinical practice. The objective of this review was to establish the amount of available evidence within leading stroke rehabilitation journals to guide the translation of evidence to practice. Method Leading journals within stroke rehabilitation were pragmatically identified by reviewing the 15 highest impact journals listed in the Thomson Reuters 2015 Journal Citation Reports in the Rehabilitation category, as well as the specialty journals Stroke and Lancet Neurology. Journals were included if they published articles pertaining to clinical care or rehabilitation for people with stroke. All research articles were independently reviewed by two reviewers to determine the type of clinical stroke research that was published in 2016. Articles were excluded if the participants were not humans with stroke, if the studies were undertaken post-mortem, or if the research was investigating solely pharmacological or surgical interventions. Included articles were categorised according to the Knowledge to Action framework as: ‘Knowledge Inquiry’, ‘Knowledge Synthesis’ and ‘Implementation and Evaluation’, plus an additional category of ‘Non-intervention studies’. Results Eight journals were included in our final review, with 1047 research articles published between January and December 2016. 763 of these articles were excluded. The included 284 articles were categorised as follows: 185 non-intervention studies (65.1% of included studies), 70 knowledge inquiry studies (24.6%), 22 knowledge syntheses (7.7%) and 7 implementation or evaluation studies (2.5%). Of the seven articles which presented implementation or evaluation of non-pharmacological, non-surgical management after stroke, three presented findings regarding delivery of rehabilitation services, whereas the remaining four articles presented findings regarding quality of care in the acute post-stroke period. One rehabilitation study evaluated the real world implementation of early supported discharge, and the other two rehabilitation studies examined physical therapists’ self-reported adherence with recommendations from clinical guidelines (electrical stimulation and provision of education about community-based exercise). Conclusions This review highlights in a striking fashion the lack of focus within the academic community on the implementation of evidence-based interventions within stroke rehabilitation practice, with less than 3% of stroke rehabilitation research published in the leading stroke rehabilitation journals addressing implementation or evaluation. Given the ongoing need for rehabilitation after stroke, it is imperative that a greater focus on implementation is shown by researchers, publishers, funders and professional bodies in order for people with stroke to benefit from the best possible evidence-based care.