Neuro-rehab’s influence within one of the world’s most relied-upon healthcare research bodies is on the rise.
Cochrane, the global organisation with systematically reviews healthcare research and underpins many of the world’s official guidelines, has provided an annual update on its fledgling rehabilitation group.
The group was launched last year to bring together rehabilitation expertise and evidence and highlight gaps where new research is needed to inform rehab decisions by professionals.
More than 230 collaborators from 49 countries backed its launch and its reach looks to have grown considerably since.
Cochrane is made up of a network of researchers, professionals, patients, carers and people interested in health with the mission of promoting evidence-informed decisions.
Within it, Cochrane fields are groups focused on particular healthcare areas, aimed at linking evidence produced by Cochrane with the external stakeholders who need it.
The rehabilitation field was established to help rehab professionals make decisions by combining evidence gathered by systematic reviews with their own clinical expertise.
The group is headquartered in Brescia, Italy, and run in collaboration with the University of Brescia and the Don Gnocchi Foundation.
Its director, Stefano Negrini, said at the time of its launch: “Producing and increasing the dissemination of the best available information on healthcare is critical for clinicians and patients everywhere in the world, especially in rehabilitation.
“Cochrane Rehabilitation will drive, on one side, evidence and methods developed by Cochrane to the world of rehabilitation and, on the other, convey priorities, needs and specificities of rehabilitation to Cochrane.”
The group’s goals include connecting rehabilitation “stakeholders” globally, translating evidence into knowledge for all areas of practice in rehab and disseminating Cochrane’s work more widely and internationally.
Work is also underway in developing a register of rehab-relevant systematic reviews and rehab-based educational activities.
The group also influences the ongoing development of Cochrane’s review methods – and works to promote both the rehab community to Cochrane, and Cochrane to rehab networks.
William Levack, reviews committee chair at Cochrane Rehabilitation, says: “There was a clear gap for a rehabilitation group.
“When we first started talking about Cochrane Rehabilitation, an initial screening revealed the vast majority of Cochrane review groups had something to do with rehabilitation.
“There were at least four groups that contained over 20 reviews that related to rehab, while there are nine review groups that are directly relevant to neuro-rehab alone, so we wanted a group made up of people from all around the world in this field.
“If we think about Cochrane as a global, independent, non-pro t network of research professionals, patients and carers and so on, Cochrane Rehabilitation is all of that, but for people interested in rehabilitation. It exists for healthcare decisions in rehabilitation.
“The group is a two-way bridge. On one hand we want to share the work of Cochrane, but we also want to inform the work of Cochrane from the perspective of clinicians, patients and policymakers in rehabilitation.”
In the next 12 months, the rehabilitation group will oversee the publishing of a rehabilitation e-book which will share rehab knowledge, while also identifying priorities for new reviews and areas of neglect not yet covered by reviews.
A director of the rehabilitation field sits on Cochrane’s Knowledge Translation Advisory Board, while two “Cochrane Rehabilitation Units” have so far submitted their “Action Business Plan”; the Turkish Society of Physical Medicine & Rehabilitation and the Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit at Glasgow Caledonian University.
A third unit has been set up at the Physical and Rehabilitation Medicine Department of the University of Campania “Luigi Vanvitelli” in Naples, which will work with Cochrane rehab’s HQ in producing the new e-book.
Lectures, sessions and workshops have been held in around 20 meetings so far, meanwhile.
Cochrane’s overall aim is to inform better healthcare decisions by gathering and summarising the best health evidence from research in themed systematic reviews.
While directly helping professionals to make vital decisions about interventions, Cochrane’s work also heavily influences offcial guidelines.
In 2016, for example, almost 90 per cent of World Health Organization guidelines produced that year used Cochrane’s systematic reviews.
Cochrane’s editor-in-chief David Tovey says: “Systematic reviews look at all the available high-quality evidence to address a particular question through a comprehensive search.
“The findings of that search are fed through a filter and, as a result, you may get a pooled estimate of effects from all the studies. Using all of those studies you are increasing your power and precision.
“Most importantly, it also gives you an opportunity to look at the risk of bias in those studies and to look at the body of evidence and make judgements.”
Cochrane users range from doctors and nurses to patients, carers, researchers and funders, while its network of contributors spans 120 countries.
Each contributor is affiliated to the organisation through Cochrane groups, which include healthcare-related review groups, thematic networks, groups concerned with the methodology of systematic reviews and regional centres.
There is no one place or office that is ‘Cochrane’. Contributors and groups are based all around the world and the majority of work is carried out online.
Each group is a “mini-organisation” in itself, with its own funding, website, and workload. Contributors affiliate themselves to a group, or in some cases several groups, based on their interests, expertise, and/or geographical location.
As well as producing systematic reviews, Cochrane contributes to the development of the methods of evidence synthesis, in part by training people who undertake systematic reviews and in shaping primary research.
Neuro-rehab research gaps
Part of Cochrane’s work involves spotting neglected areas of research – of which there and many in neuro-rehab. Here are some recently identified areas which, although showing promise, lack the robust data needed to support definitive decisions:
Fitness training and traumatic brain injury recovery
A review of eight studies involving 67 participants concluded that: “There is low-quality evidence that fitness training is effective at improving cardiorespiratory deconditioning after TBI; there is insuficient evidence to draw any definitive conclusions about the other outcomes. Whilst the intervention appears to be accepted by people with TBI, and there is no evidence of harm, more adequately powered and well-designed studies are required to determine a more precise estimate of the effect on cardiorespiratory fitness, as well as the effects across a range of important outcome measures and in people with different characteristics (e.g. children).”
Interventions for eye movement disorders due to acquired brain injury
Cochrane analysed five studies, including one involving botulinum toxin and another which compared eye movement training with sham (false) training in people with mild traumatic brain injury. Cochrane said: “The included studies provide insufficient evidence to inform decisions about treatments specifically for eye movement disorders that occur following acquired brain injury. No information was obtained on the cost of treatment or measures of participant satisfaction relating to treatment options and effectiveness.”
Respiratory muscle training and MS
Cochrane’s researchers looked at various trials, including two which tested inspiratory muscle training with a threshold device, three involving expiratory muscle training with a threshold device, and one based on breathing exercises. They concluded: “This review provides low-quality evidence that resistive inspiratory muscle training with a resistive threshold device is moderately effective post-intervention for improving predicted maximal inspiratory pressure in people with mild to moderate MS, whereas expiratory muscle training showed no significant effects. The sustainability of the favourable effect of inspiratory muscle training is unclear, as is the impact of the observed effects on quality of life.”