Governance arrangements for rehabilitation services in health systems: an overview of systematic reviews
Notice bibliographique
Résumé
BACKGROUND: Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Programme have collaborated to produce four Cochrane overviews of systematic reviews that synthesize current available evidence from health policy and systems research (HPSR) in rehabilitation. Each overview focuses on one of the four pillars of HPSR as identified by the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy: delivery arrangements, financial arrangements, governance arrangements, and implementation strategies. This overview focuses on governance arrangements, defined in the EPOC taxonomy as the rules or processes that affect the way in which powers are exercised, particularly regarding authority, accountability, openness, participation, and coherence. OBJECTIVES: This overview aimed to synthesize the current evidence on governance arrangements in rehabilitation from a health policy and systems research (HPSR) perspective. Our series of four overviews, incorporating evidence on governance arrangements, delivery arrangements, financial arrangements, and implementation strategies, have the following overarching objectives. • To offer a broad synthesis of the existing evidence on health policy and systems interventions' effects. • To direct end-users, including policymakers, towards systematic reviews that may address their health policy questions. • To identify current research gaps and set priorities for future primary HPSR. • To pinpoint the needs and priorities for new evidence syntheses where no reliable, up-to-date systematic reviews currently exist. METHODS: We searched the Epistemonokos database, the Health Systems Evidence database, and EPOC Group systematic reviews to identify reviews published between 1 January 2015 and 17 November 2024. We applied no language limitations. We included Cochrane and non-Cochrane systematic reviews of randomized controlled trials (RCTs) and selected non-randomized studies of interventions (NRSIs) that evaluated the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to governance arrangements as defined in the EPOC taxonomy. All four overview teams collaborated to screen reviews and extract data. We used AMSTAR-2 to critically appraise the quality of the reviews. Reviews with ratings of high-to-moderate confidence are reported separately from low-confidence reviews. MAIN RESULTS: We found no Cochrane or non-Cochrane systematic reviews of RCTs or NRSIs pertaining to rehabilitation and relevant to the EPOC pillar of governance arrangements. As a result, we are unable to offer a broad synthesis of the existing evidence or to signpost relevant reviews on health policy and systems interventions related to this pillar for end-users. We did describe relevant research gaps and priorities for future primary HPSR in the rehabilitation field. AUTHORS' CONCLUSIONS: We found no evidence to address our research objectives of understanding the broad effects of governance arrangements for rehabilitation or identifying evidence that could help end-users, including decision-makers and policymakers, to address potential related health policy questions. Authors of future Cochrane overviews of reviews in HPSR focusing on governance and rehabilitation may wish to consider including systematic reviews with a broader range of observational designs, as well as qualitative and mixed-methods research designs. FUNDING: This Cochrane review was funded by the Italian Ministry of Health (Ricerca Corrente). The funder played no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. REGISTRATION: The protocol was first published in the European Journal of Physical and Rehabilitation Medicine online on 27 January 2025. The manuscript was received on 11 November 2024 and was accepted on 26 November 2024. PROTOCOL: DOI 10.23736/S1973-9087.24.08833-6.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,052 | 0,181 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,002 |
| Méta-épidémiologie (sens large) | 0,008 | 0,009 |
| Bibliométrie | 0,046 | 0,037 |
| Études des sciences et des technologies | 0,002 | 0,003 |
| Communication savante | 0,007 | 0,008 |
| Science ouverte | 0,003 | 0,005 |
| Intégrité de la recherche | 0,004 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».