Article

Rehabilitation is highly complex, involving multiple processes,
outcomes and stakeholders. The way we deliver our services and work with our
clients and their families should be informed by research approaches that produce
the wide range of knowledge needed. This article aims to explore the degree to
which the dominant approach to 'evidence' (the randomised clinical trial or RCT)
meets those needs and discuss alternate/additional ways of gaining evidence.
METHODS: A critical review of the literature allowing exploration of problems
encountered in rehabilitation RCTs and alterative approaches. FINDINGS: We
discuss some problematic issues related to using RCTs in rehabilitation research
(for example the large number of people excluded from trials, and the small
numbers of people with some neurological conditions making RCTs non-viable).
Alternative approaches are discussed including clinical practice improvement
studies (sometimes called practice-based evidence or PBE), which provide data on
patients treated in routine practice; qualitative research, which can provide an
understanding of the users of health care services to ensure they are meeting
their needs; and metasynthesis, which can be used to summarise several
qualitative studies to enhance our understanding of the principles underlying
service delivery. Finally, we explore how clinicians and commissioners often use
evidence generated by forms of research other than the RCT. CONCLUSION: The best
answers about how to enhance rehabilitation outcomes are likely to come from a
combination and integration of the most appropriate methods. In conclusion, we
urge for more joined up thinking, for learning from different fields so that we
can develop more effective and appropriate health care and rehabilitation.
Orthophonie - kinésithérapie
Ergothérapie - psychologie

Langue : ANGLAIS