Methodological difificulties in rehabilitation research

Abstract

This paper presents an overview of some of the pitfalls and suggests ways of improving the quality of research into rehabilitation after stroke. The aims of rehabilitation are outlined and methodological problems inherent in this area discussed, including spontaneous recovery, multidimensional outcomes, definition of treatment and placebo effects. Major weaknesses found in the rehabilitation literature are identified and recommendations for improvement made, including the need for comparable controls, adequate numbers, appropriate outcome measures, clear definition of therapy, generalizability, and a concern for the cost-effectiveness of stroke rehabilitation packages. The field of rehabilitation is still relatively new and idiosyncratic in form and content. Thus it still provides opportunities for research into its relative effectiveness before current practices in rehabilitation become entrenched in medical practice and folklore. Adequate funding support for improved, multicentre clinical trials in rehabilitation is essential.