Abstract 3111: Translating Evidence into Clinical Practice: Can it Always Be Done? The Example of Intensive Stroke Rehabilitation
Bibliographic record
Abstract
Background and Purpose: While it remains unclear how much therapy patients should receive to maximize motor recovery, specifically during inpatient rehabilitation, recommendations regarding the daily minimum dose of therapy are included in many clinical practice guidelines. Since these documents are evidence-based, we examined the related literature to determine if a specific recommendation could be supported. Methods: Six clinical practice guidelines were retrieved and examined to determine what recommendation, if any, had been made regarding the daily provision of therapy during inpatient rehabilitation. We then identified all studies cited by the guideline authors to support their recommendations. Studies in which treatment was focused on motor recovery, were initiated during inpatient rehabilitation and provided within 3 months of stroke onset were reviewed in greater detail. Study design, details of the therapy contrasts, the duration of scheduled daily therapy (min/day), actual therapy received (min/day), the primary outcome and the results, were noted for each trial. Results: Three of the 6 identified guidelines recommended daily minimum amounts of therapy, ranging from 45 to 60 minutes each day of occupational (OT) and physiotherapy (PT), one made no recommendation, and two made general statements indicating that increased intensity of therapy was either recommended or was not recommended. Among the 6 guidelines, a total of 73 studies had been cited to support the recommendations. Sixteen randomized controlled trials and 2 controlled trials were reviewed in detail. The majority of trials not reviewed further examined treatments provided in the chronic stage of stroke and/or were non-hospital based. Treatment contrasts included comparisons of intensive inpatient rehabilitation vs. standard inpatient therapy or standard inpatient therapy plus additional therapy provided by OT and/or PT vs. standard therapy only. Details of daily therapy either prescribed or received was included in 9 studies. Patients in the control condition received an average of 48 minutes of therapy per day while those in the experimental group received an average of 61% more, or 77 minutes per day. In only 6 (33%) studies did patients in the experimental group perform significantly better on the primary outcome compared with those in the control group. Conclusions: Although included in several best practice guidelines, we believe the evidence base cannot support a specific recommendations related to therapy intensity during inpatient rehabilitation following stroke.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.107 | 0.417 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.004 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.005 |
| Scholarly communication | 0.011 | 0.015 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.012 | 0.010 |
| Insufficient payload (model declined to judge) | 0.008 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".