From evidence to action: Rehabilitation, evidence synthesis, and Cochrane Rehabilitation
Authors: Claudio Cordani1,2, Matteo Johann Del Furia1,2,3, Irene Battel1
1. Department of Biomedical, Surgical and Dental Sciences, University “La Statale”, Milan, Italy
2. IRCCS Galeazzi Sant’Ambrogio Hospital, Milan, Italy
3. Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
Rehabilitation is a vital component of health care, enabling individuals to regain functioning, independence, and quality of life following injury, illness, or disability. However, the growing global demand for rehabilitation services—driven by aging populations and the rising prevalence of chronic diseases—is unmet, putting significant pressures on health systems worldwide (WHO 2017).
For this reason, the World Health Assembly (WHA) adopted the first-ever resolution on “Strengthening Rehabilitation Services in Health Systems” in May 2023. This initiative requested action from countries, stakeholders, and the World Health Organization (WHO) to address the rapid global growth of the need for rehabilitation services (Cieza et al. 2021; WHO 2017). It is within this context that the theme of “Health and beyond: From evidence to action” becomes critically important. Evidence-based rehabilitation, supported by rigorous evidence synthesis and organizations such as Cochrane, has the potential to transform the delivery of rehabilitation services, ensuring that they are both effective and accessible across diverse health care settings.
The role of evidence synthesis in rehabilitation
Rehabilitation is a “multimodal, person-centered, collaborative process, including interventions targeting a person’s capacity (by addressing body structures, functions, and activities/participation) and/or contextual factors related to performance to optimize the functioning of persons with health conditions currently experiencing disability or likely to experience disability, or persons with disability”(Negrini et al. 2022). Due to its complex nature, this makes the need for reliable, high-quality evidence even more essential (Levack et al. 2024).
Evidence synthesis refers to the process of systematically collecting and evaluating research findings from multiple studies to provide an overall assessment of the effectiveness of a given intervention. In the context of rehabilitation, evidence synthesis is invaluable, as it allows clinicians to make informed decisions based on the best available evidence. This, in turn, promotes the delivery of safe, effective, and patient-centered care (Negrini et al. 2016). However, rehabilitation research faces several challenges that make evidence synthesis both necessary and difficult. The heterogeneity of interventions, the variability in patient populations, and the often long-term nature of rehabilitation outcomes complicate traditional research methodologies, such as randomized controlled trials. As a result, rehabilitation research frequently includes pragmatic trials, cohort studies, and qualitative research, which must be carefully synthesized to provide a comprehensive picture of what works and what doesn’t in rehabilitation.
Cochrane Rehabilitation: Bringing the evidence synthesis leaders into rehabilitation
Cochrane Rehabilitation was established in 2016 as a field within the Cochrane network, with the specific aim of addressing the unique challenges and needs of the rehabilitation field. The mission of Cochrane Rehabilitation is to improve the production, synthesis, dissemination, implementation, and impact of rehabilitation evidence at an individual, organizational, and health policy level, with a global view beyond professions, culture, language, and economic resources.
One of Cochrane Rehabilitation’s key contributions is the creation of accessible, high-quality reviews that bridge the gap between research and practice. By systematically reviewing the literature, Cochrane Rehabilitation provides clear, actionable insights into the effectiveness of various rehabilitation interventions. These reviews not only inform clinical practice but also contribute to the development of guidelines and policies, ensuring that rehabilitation services are grounded in the best available evidence.
To broaden its remit to the larger scope of functioning and disability, Cochrane Rehabilitation applied to become a Thematic Group. These are new groups in the evolving Cochrane community that will play a pivotal role in planning and prioritizing research, assisting the Central Editorial Service, collaborating with Evidence Syntheses Units, and disseminating Cochrane evidence. At the Global Evidence Summit last September in Prague, it was approved as one of the five new groups under the name “Cochrane Functioning, Disability and Rehabilitation.”
Moving from evidence to action: Knowledge translation and stakeholder involvement in rehabilitation
While the synthesis of evidence is crucial, it is only the first step in transforming health care. The real challenge lies in moving from evidence to action—ensuring that the findings from systematic reviews are implemented in clinical practice and policy. This process, often referred to as knowledge translation, is especially important in rehabilitation, where the complexity of interventions and the diversity of patient needs can make evidence implementation difficult (Cordani & Battel 2024; Negrini et al. 2016). Working together to ensure that evidence reaches those who need it most is the cornerstone of knowledge translation. This includes creating resources that are accessible to clinicians, such as summary reports, decision aids, and clinical guidelines (Oral et al. 2020).
To achieve this, Cochrane Rehabilitation works closely with international organizations like the WHO to integrate evidence into global health policies (Negrini et al. 2021). Furthermore, Cochrane actively promotes stakeholder engagement, which is steadily increasing through the involvement of patients and consumers in the evidence synthesis process. Stakeholders contribute at various stages, from defining priorities and review questions to providing valuable feedback on research protocols and results.
This inclusive approach offers several benefits: it enhances transparency, helps predict controversies around review outcomes, ensures the use of widely accepted definitions, increases methodological rigor (e.g., in search strategies), provides access to gray literature, facilitates tailored communication strategies, and supports evidence-informed decision-making.
The future of rehabilitation lies in evidence-based practice
The theme of “Health and beyond: From evidence to action” highlights the importance of translating evidence into practice to improve health outcomes worldwide. In rehabilitation, where complexity and variability are the norms, evidence-based practice is crucial for delivering high-quality, person-centered care. Cochrane Rehabilitation plays a pivotal role in advancing rehabilitation practice on a global scale.
Cochrane Rehabilitation has implemented several knowledge translation initiatives to bridge the gap between research and clinical practice:
1. Website: a central hub for accessing resources and publications (https://rehabilitation.cochrane.org)
2. Cochrane Corners (https://rehabilitation.cochrane.org/node/22)
3. Newsletter: A primary communication channel for disseminating information, including knowledge translation products, publication and updates relevant for clinical practice (https://rehabilitation.cochrane.org/resources/newsletter)
4. Blogshots: infographics summarizing key findings from a single Cochrane Review, now available in 14 languages (https://rehabilitation.cochrane.org/resources/blogshots)
5. Social media channels: used to share impactful information and publication with all the stakeholders
As we look to the future, the continued growth of evidence-based rehabilitation will be essential for addressing the increasing demand for services and improving the lives of millions of individuals with chronic conditions, disabilities, and injuries. By moving from evidence to action, we can ensure that rehabilitation is not only effective but also accessible to all who need it, regardless of where they live or the resources available to them.
Take-home messages:
- The importance of evidence in rehabilitation: Rigorous evidence synthesis, promoted by organizations such as Cochrane Rehabilitation, is crucial for enhancing the quality and accessibility of rehabilitation services globally. It helps bridge the gap between research and clinical practice, ensuring effective and patient-centered care.
- From knowledge to action: Translating evidence into practice is essential for advancing rehabilitation. Cochrane Rehabilitation, in collaboration with international organizations, leads this process by making evidence accessible to clinicians and integrating it into global health policies.
References
World Health Organization. (2017). Rehabilitation in health systems. https://iris.who.int/bitstream/handle/10665/254506/9789241549974-eng.pdf?sequence=8.
Cieza, A., Causey, K., Kamenov, K., Hanson, S. W., Chatterji, S., & Vos, T. (2021). Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England), 396(10267), 2006–2017. https://doi.org/10.1016/S0140-6736(20)32340-0
Negrini S., Selb, M., Kiekens, C., Todhunter-Brown, A., Arienti, C., Stucki, G., Meyer, T., & 3rd Cochrane Rehabilitation Methodology Meeting participants (2022). Rehabilitation definition for research purposes. A global stakeholders' initiative by Cochrane Rehabilitation. European Journal of Physical and Rehabilitation Medicine, 58(3), 333–341. https://doi.org/10.23736/S1973-9087.22.07509-8
Levack, W. M., Gross, D. P., Martin, R. A., Every-Palmer, S., Kiekens, C., Cordani, C., Negrini, S., & Participants in the 5th Cochrane Rehabilitation Methodological Meeting ‡ (2024). Designing studies and reviews to produce informative, trustworthy evidence about complex interventions in rehabilitation: a narrative review and commentary. European journal of physical and rehabilitation medicine, 10.23736/S1973-9087.24.08459-4. Advance online publication. https://doi.org/10.23736/S1973-9087.24.08459-4
Negrini, S., Kiekens, C., Levack, W., Grubisic, F., Gimigliano, F., Ilieva, E., & Thorsten, M. (2016). Cochrane Physical and Rehabilitation Medicine: A New Field to Bridge Between Best Evidence and the Specific Needs of Our Field of Competence. Physical therapy, 96(7), 1109–1110. https://doi.org/10.2522/ptj.2016.96.7.1109
Negrini, S., Gimigliano, F., Arienti, C., & Kiekens, C. (2018). Knowledge Translation: The Bridging Function of Cochrane Rehabilitation. Archives of Physical Medicine and Rehabilitation, 99(6), 1242–1245. https://doi.org/10.1016/j.apmr.2017.11.002
Cordani, C., & Battel, I. (2024). Do implementation interventions improve evidence-based care in acute stroke settings? A Cochrane Review summary with commentary. NeuroRehabilitation, 54(2), 343–346. https://doi.org/10.3233/NRE-246002
Oral, A., Arienti, C., Lazzarini, S. G., Grubišić, F., Kiekens, C., & Negrini, S. (2020). The Cochrane Corners by Cochrane Rehabilitation. European Journal of Physical and Rehabilitation Medicine, 56(4), 529–534. https://doi.org/10.23736/S1973-9087.20.06258-9
Negrini, S., Arienti, C., Patrini, M., Kiekens, C., Rauch, A., & Cieza, A. (2021). Cochrane collaborates with the World Health Organization to establish a Package of Rehabilitation Interventions based on the best available evidence. European Journal of Physical and Rehabilitation Medicine, 57(3), 478–480. https://doi.org/10.23736/S1973-9087.21.07075-1
To link to this article - DOI: https://doi.org/10.70253/ACUR7861
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