The Stroke Therapy Evaluation Progrannne(STEP): An Attempt To Introduce A Culture Of Evidence-Based Practice Into Stroke Rehabilitation.

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Authors
Sellars C, Langhorne P, Legg L, Pollock A
Abstract
Introduction: Several difficulties in conducting systematic reviews of rehabilitation practice have been identified: these include definition of diagnostic conditions, therapists, and interventions; low subject numbers; selection and interpretation of outcome measures; limitations of study design; and inadequate reporting (Greener, J and Grant, A: Issues and problems in rehabilitation reviews, and how these may be addressed. Cochrane Colloquium Proceedings, Amsterdam, 1997). These difficulties limit the potential for achieving evidence-based stroke rehabilitation

Objectives: The aim of this project is to establish a programme to facilitate evidence-based stroke rehabilitation.

Methods: The Stroke Therapy Evaluation Programme (STEP) was established by Chest Heart and Stroke Scotland in late 1998. STEP personnel includes a rehabilitation doctor, a physiotherapist, an occupational therapist, and a speech and language therapist. The specific aims of STEP are a) to carry out a user-consultation process involving rehabilitation professionals, patients and carers in order to develop a set of research priorities; b) to undertake systematic reviews of stroke rehabilitation from a non-medical perspective; c) to carry out an educational programme among rehabilitation professionals aimed at improving awareness of evidence-based practice; d) to establish a training and resource centre for fellow rehabilitation professionals interested in evidence-based practice and in conducting systematic reviews.

Results: To date, 2 major interdisciplinary study days promoting evidence-based practice have taken place; a substantial user consultation exercise has been conducted; 6 systematic reviews are being undertaken by team members or under the guidance of the team; and 6 critical appraisal workshops have been conducted by members of the team. A regular newsletter is now being published. Further activities are planned or underway.

Discussion: We hope that the STEP project offers an important step forward in addressing some of the difficulties in making the rehabilitation process more amenable to systematic review and evidence-based practice.