Research-based evidence in stroke rehabilitation: an investigation of its implementation by physiotherapists and occupational therapists

Stroke rehabilitation is a multidimensional process that is designed to facilitate restoration of and/or adaptation to loss of functioning. Occupational therapy and physiotherapy constitute important contributions to rehabilitation.

The study aim was to investigate characteristics of the implementation of research-based evidence in stroke rehabilitation by occupational therapists and physiotherapists, using the International Classification of Functioning, Disability and Health as a conceptual framework.

In this prospective cohort study, all service levels within stroke rehabilitation were included. Consecutive patients with stroke admitted to a university hospital between May and December 2012 were enrolled by 13 therapists, with a total of 131 patients participating in the study. Documentation of daily practice was collected from medical records. Analysis compared the therapists’ documentation with the national clinical guidelines for physiotherapy and occupational therapy in the rehabilitation of adults with brain injury.

The therapists’ praxis was seen to be in agreement with the majority of the national clinical guidelines. However, joint goal-setting and evaluation using standardized measures were seldom documented. Although the therapists recognize evidence-based practice as a framework for achieving quality in rehabilitation, the study suggests that they do not employ research-based evidence to the fullest extent.  

With the intention of enabling meaningful participation the health professionals need to pay more attention to the importance of environmental factors. Both guidelines and clinical practice should consider all components of the International Classification of Functioning, Disability and Health when formulating, and implementing, recommendations in rehabilitation praxis in order to aim for rehabilitation that is based both on evidence and a holistic approach.

In order to individualize the rehabilitation offered, more attention and focus on involving and giving words to patients’ expectations, perceptions, experiences, and perspectives is needed.