Toward improved evidence standards and methods for rehabilitation: recommendations and challenges

Area of Science:

• Rehabilitation Science
• Evidence-Based Practice
• Knowledge Translation

Background:

• Current systematic review and practice recommendation systems face challenges when applied to disability and rehabilitation.
• Existing methods require adaptation to effectively synthesize evidence in this field.

Purpose of the Study:

• To identify challenges in evidence synthesis and practice recommendations for disability and rehabilitation.
• To propose improved methods for evidence synthesis and knowledge translation in this domain.

Main Methods:

• Explication of criteria for evaluating nonrandomized evidence (e.g., regression discontinuity, interrupted time series).
• Increased use of meta-analysis and consideration of effect size, bias direction, and dose-response.
• Development of review methods for assistive technology and measurement procedures.
• Improved application to practice through attention to treatment alternatives and generalizability.

Main Results:

• Enhanced evidence synthesis can be achieved by refining evaluation of nonrandomized studies and increasing meta-analysis.
• Improved practice application involves considering clinical experience and focusing on the best available evidence.
• Outcomes should be measured and reviewed in terms meaningful to individuals with disabilities.

Conclusions:

• Methods exist to significantly improve evidence synthesis and knowledge translation in disability and rehabilitation.
• Adoption of these refined methods will lead to more effective interventions and programs.