Background: The Stroke Therapy Evaluation programme (STEP) was established to provide stroke rehabilitation clinicians, patients and carers with the current best evidence to help make informed decisions about healthcare interventions.

Objective: To identify important gaps in evidence about stroke rehabilitation.

Methods: The project has four stages: 1) Topic identification: a consultation with professionals working in the field of stroke rehabilitation and extensive examination of educational and research literature, established a range of questions covering i) alternative ways of organising stroke rehabilitation services, and ii) the management of specific clinical topics. 2) Evidence searching: We searched the Cochrane Library, Database of Abstracts of Reviews of Effectiveness and the Cochrane Stroke Group specialised trials register for trial evidence relating to each topic (focussing on systematic reviews of RCTs). 3) Evidence summary: Each study identified is appraised for methodological quality. The evidence relating to each question is assessed for the size of benefit/ harm and degree of certainty and summarised in a structured manner. 4) Identification of topics which lack reliable evidence:

Results: To date we have searched for and appraised the evidence for 134 interventions. Of the 134 interventions assessed, two (1.5%) were rated as beneficial, 23 (17.2%) likely to be beneficial, 81 (60.4%) unknown effectiveness, 9 (6.7%), 6 (4.5%) likely to be ineffective or harmful and 13 (9.7%) were systematic reviews in progress i.e Cochrane protocols.

Conclusions: This comprehensive, accurate, up-to-date information highlights the gaps in the current stroke rehabilitation evidence base and provides direction for future primary and secondary research opportunities. Full details of evidence in stroke rehabilitation is available at effectivestrokecare.org.

References: 1. Clinical Evidence, Issues 1 9 BMJ Publishing Group, London.