Article

Interventions and programs for people with disability should be based on the best - the most discriminating and rigorous - methods of systematic review and
knowledge translation possible. Extant systems for systematic review and practice
recommendations have excellent features but severe difficulties are encountered
when attempting to apply them to disability and rehabilitation.
This article
identifies issues in evidence synthesis and linked practice recommendations and
describes both new and long-tested methods to address them. Evidence synthesis in
disability and rehabilitation can be improved by : explicating criteria for
evaluating nonrandomized evidence, including the regression discontinuity,
interrupted time series, and single-subject designs, as well as state-of-the-art
methods of analysis of observational studies ; greater use of meta-analysis;
considering effect size, direction of biases, and dose-response relationships;
employing more discriminating methods of evaluating flaws in masking, considering
also measurement reliability and objectivity; considering overall biases and
conflicts of interest; increased attention to composition of review panels; and
greater transparency in reporting of the bases of reviewers' judgments. Review
methods need to be developed for assistive technology and for measurement
procedures. Application to practice can be improved by attention to treatment
alternatives, explicit evaluation of generalizability, synthesizing clinical
experience as a source of evidence, and a focus on the best--rather than the
ideally most-rigorous--evidence. Study outcomes should be measured and reviewed
in terms meaningful to persons served. In sum, methods are available to improve
evidence synthesis and the application of resulting knowledge. We recommend that
these methods be employed.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS