Searching for high quality evidence might be the right thing to do if you haven’t found a relevant guideline, however, this can be very time consuming. (See the Evidence and Evidence based guidelines topic loops on the right for information).
A simple literature search would combine the terms “stroke” AND “physiotherapy” AND “amount”
| Where? | URL link | What would I find? |
| Cochrane library | www.thecochranelibrary.com | More than 75 Cochrane reviews |
| DORIS | www.askdoris.org | More than 15 Cochrane reviews and other systematic reviews |
| Knowledge Network | www.knowledge.scot.nhs.uk | More than 75 research articles |
Q. What do the results of this search tell me? Select True or False for each statement.
Which ever method you used (i.e. by either looking at the national guideline or by undertaking a search for high quality evidence) you now know that there is no one clear simple answer to the question relating to the best amount of physiotherapy after stroke:
- From looking at the relevant SIGN guideline you know that increased intensity of intervention is recommended for gait problems, but not for upper limb function
- Royal College of Physicians guideline for stroke 2012 suggests 45 minutes of tharapy for 5 days a week if the patient continues to benefit and can tolerate this.
- Searching for high quality evidence has confirmed that there is a complex body of evidence and acknowledged uncertainties relating to this question
Your challenge is to put this in a simple way within your response to the letter of complaint!
Topic Loops:
Q. What do the results of this search tell me?
1. There is clearly some synthesised evidence in the form of systematic reviews. I will read the one with the most relevant title and hope it tells me what I need to know. – False – There is clearly not one systematic review which is specific to your question.
There may be a large number of related reviews and no one obvious summarising review because the evidence is particularly complex or contentious. You should refer to the national guidelines in the first instance to make sure you don’t waste your time!
2. There is clearly some synthesised evidence in the form of systematic reviews. I will need to read them all to give me a full understanding of the evidence base. – False – Doing this is admirable – but are you sure this is best use of your time? Browsing the systematic reviews you can see that there are several reviews relating to intensity and amount of therapy. Some are just related to one outcome (e.g. arm recovery). Some are clearly relevant but several years out of date.
You should refer to the national guidelines in the first instance to make sure you don’t waste your time!
3. There is clearly some synthesised evidence in the form of systematic reviews. However from the titles I do not feel confident that I can choose the relevant reviews which I need to read. – True – The large number of reviews with similar / related titles tells you that this is probably a complex body of evidence.
Furthermore you have noted that there are acknowledged uncertainties relating to this question.
You should refer to the national guidelines in the first instance to make sure you don’t waste your time!
4. There are lots of RCTs. I will read all the reports of these. – False – Doing this is admirable but you must have better ways to spend your time! Because there are lots of systematic reviews you feel it is not appropriate to look at it is probably not necessary to look at any of the individual RCTs.
You should refer to the national guidelines in the first instance to make sure you don’t waste your time!
5. I am confident that there is no clear answer to this question. – True – You can be confident that there is no clear answer to this question because on DORIS you note that there are a number of ‘uncertainties’ relating to physiotherapy and intensity . This tells you that there are unanswered research questions about the best amount of physiotherapy.
You should refer to the national guidelines.
Page last reviewed: 29 Apr 2020
