Optimizing the real-world impact of rehabilitation reviews: increasing the relevance and usability of systematic reviews in rehabilitation

Understanding the certainty of evidence from systematic reviews in rehabilitation science: what do clinicians need to know about GRADE?

PURPOSE

Systematic reviews of interventions are published each year evaluating rehabilitation approaches such as exercise, manual therapy, or electrotherapy. Currently, important methodological approaches are available to make systematic reviews more robust and transparent. One of these approaches is the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) system.

MATERIAL AND METHODS

A perspective for rehabilitation was conducted aiming to (1) shed light on the meaning and relevance of the GRADE system in systematic reviews with meta-analysis of rehabilitation science, and (2) propose suggestions for helping clinicians improve the interpretation of the GRADE findings.

RESULTS

The meaning and relevance of GRADE in rehabilitation science was discussed. Suggestions were proposed to help clinicians in the interpretation of the GRADE findings. We discussed the use of meta-analyses, meta-regressions, subgroups meta-analyses, and sensitivity analyses to increase the objectivity of the domains of GRADE. Finally, a future agenda was provided.

CONCLUSION

The use of GRADE is essential for improving the synthesis of evidence that clinicians may often use in rehabilitation practice. However, GRADE is only one hallmark when the findings of systematic reviews are interpreted. The issues of sample size, futile research, pre-registration, switching outcomes, or narrative bias should be also considered.

The influence of contextual factors on an intervention for people with disabilities from support persons' and health personnel's perspectives: a focus group study

Introduction

Contextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMD). Exploring support persons' and health personnel's experience of an intervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons' and health personnel's experience of contextual factors during involvement in an intervention for people with PIMD.

Methods

This focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach.

Results

Three themes emerged from the analysis of the informants' perspectives on the contextual factors: (1) structure and support enhances intervention feasibility; (2) an intervention's benefit for people with PIMD increases its acceptability; and (3) being engaged and involved increases support persons' and health personnel's motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan. A training programme should be provided for the recipients and providers of the intervention.

Discussion

Finally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities.

Workplace-Based Interventions for Mental Health in Africa: A Scoping Review

Mental health problems are one of the leading contributors to the global burden of disease. Workplaces provide a valuable and accessible setting for interventions to improve worker health. However, little is known about mental health interventions on the African continent, particularly those based in the workplace. This review aimed to identify and report on the literature about workplace-based interventions for mental health in Africa. This review followed the JBI and PRISMA ScR guidelines for scoping reviews. We searched 11 databases for qualitative, quantitative and mixed-methods studies. The grey literature was included, and no language or date limits were applied. Title and abstract screening and full text review, were completed independently by two reviewers. A total of 15 514 titles were identified, of which, 26 titles were included. The most common study designs were qualitative studies (n = 7) and pre-experimental, single-group, pre-test, post-test studies (n = 6). Workers with depression, bipolar mood disorder, schizophrenia, intellectual disability, alcohol and substance abuse, stress and burnout were included in the studies. The participants were mostly skilled and professional workers. A wide variety of interventions were offered, of which, most were multi-modal. There is a need to develop multi-modal interventions in partnership with stakeholders, particularly for semi-skilled and unskilled workers.

Evaluating the Dissemination and Implementation Impact of a Rehabilitation Intervention: The Graded Repetitive Arm Supplementary Program (GRASP)

Purpose

To evaluate the dissemination and implementation impacts of a rehabilitation intervention.

Methods

Systematic evaluation of data sources including academic publishing metrics, publications, and surveys was used to describe the dissemination and implementation impact of the graded repetitive arm supplementary program (GRASP). Three categories in the Payback Framework were evaluated: knowledge production and dissemination, benefits to future research and research use, and real-world uptake and implementation.

Results

In the Knowledge production and dissemination category, seven publications, authored by the GRASP research team, were associated with the GRASP, and there were approximately 17,000 download counts of GRASP manuals from the website from 120 countries. In the Benefits to future research and research use category, 15 studies and 8 registered clinical trials, authored by researchers outside of the GRASP team, have used GRASP as an intervention. In the real-world uptake and implementation category, GRASP has informed recommendations in 2 clinical guidelines and 20 review papers, and had high implementation uptake (e.g., 35% [53/154] of UK therapists surveyed had used GRASP; 95% [649/681] who downloaded GRASP had used it). More than 75% of those who had used GRASP identified that GRASP provides more intensity in upper extremity rehabilitation, is evidence-based and easy to implement, and the equipment and manual are easy to obtain.

Conclusion

The Payback Framework is useful to evaluate the dissemination and implementation impacts of a rehabilitation intervention. GRASP has been implemented extensively in clinical practice and community in a relatively short time since it has been developed.

Workplace-based occupational therapy for mental health in Africa: a scoping review protocol

INTRODUCTION

Although mental health at work is a pressing and growing concern, mental healthcare accounts for less than 2% of global healthcare, with marked inequality across continents. Africa has the smallest proportion of mental health service providers, and the highest rate of out-of-pocket expenditure for mental health service users. Poor mental health at work results in costs to workers, employers and the economy. This review aims to collaborate with stakeholders to identify literature on workplace-based occupational therapy interventions supporting the mental health of workers in Africa.

METHODS AND ANALYSIS

We will search Medline (PubMed), EBSCOhost (Academic Search Premier, AfricaWide Information, CINAHL, Health Source: Nursing/Academic), Scopus, Web of Science, Sabinet, Cochrane and OTSeeker for qualitative and quantitative primary research studies. Grey literature will be searched via Sabinet and ProQuest. No language or date restrictions will be applied. Title and abstract screening as well as full-text screening will be done independently by two reviewers. Data extracted will include information about the articles, characteristics of studies and interventions, and findings. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines will be used for reporting results. Three groups of stakeholders will be consulted during the review process: service users/workers, employers and service providers/occupational therapists.

ETHICS AND DISSEMINATION

This scoping review does not require ethics approval. Findings of the review will be disseminated through stakeholder engagements, peer-reviewed publications and conference presentations.

Evidence-Based Rehabilitation for Multiple Sclerosis Made Easy: The Online Applying Evidence with Confidence (APPECO) Platform

With the current rate in growth of evidence in multiple sclerosis (MS) rehabilitation, systematic reviews and clinical guidelines typically lag behind the most currently published research findings. In addition, most health care professionals lack the time, resources, or adequate skills to identify and evaluate new evidence, and hands-on tools to implement the latest evidence into clinical practice are often lacking or not readily available. The Applying Evidence with Confidence (APPECO) platform is a newly developed online tool that addresses these key challenges. APPECO was initiated as a proof-of-concept for the common MS symptoms fatigue and cognitive function. Subsequently, intervention studies about depression, pain, and mobility were added. APPECO currently hosts detailed information from 250 randomized clinical trials, 293 interventions, and 1250 effect sizes on 53 patient outcomes. Few studies with high quality (ie, low risk of bias) are available specifically designed to test the benefits of MS rehabilitation on fatigue (n = 5 [2.4%]), cognitive function (n = 4 [1.6%]), and depression (n = 2 [0.8%]). No high-quality studies were included for pain and mobility. APPECO has the potential to address key challenges in evidence-based rehabilitation medicine for MS and to facilitate swift knowledge translation from evidence into clinical practice. Sustainability of APPECO depends on a continuous resource impulse (eg, financial, time, editorial management, platform maintenance) to ensure up-to-date information across all relevant MS symptoms and activity limitations (≈2-6 randomized controlled trials per month). Ways to optimize knowledge translation in the absence of high-quality evidence in APPECO need to be explored further.

Use of multi-attribute decision-making to inform prioritization of Cochrane review topics relevant to rehabilitation

BACKGROUND

Limited resources imply the need for prioritization; this also applies to the conduct of Cochrane Reviews. Therefore, processes for identifying the most important topics for review should be determined.

AIM

The aim of this study was to describe some examples of prioritization approaches used within Cochrane; to introduce the concept of multi-criteria decision analysis, provide an example of how this is being used to determine the relative importance of research questions in musculoskeletal health by the Australasian Musculoskeletal Clinical Trials (ANZMUSC) network and how a similar approach could be used to inform Cochrane Rehabilitation priorities.

METHODS

A narrative overview of the Cochrane Methods Priority Setting Group and new guidance from Cochrane on priority setting; a description of the ANZMUSC prioritization project and the proposed outline of a prioritization process that could be undertaken by Review Groups related to rehabilitation.

RESULTS

There are no explicit processes for prioritization for Cochrane Reviews that involve multi-criteria decision making, even though such approaches appear to be potentially useful and may overcome some disadvantages of alternative approaches.

DISCUSSION

Although the ANZMUSC prioritization project is not yet complete nor shown to be successful, it may offer a useful road-map for developing a transparent method of prioritizing which research topics to pursue, in a way that could be easily implemented and updated.