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SYSTEMATIC REVIEW   Open accessopen access

European Journal of Physical and Rehabilitation Medicine 2022 August;58(4):520-9

DOI: 10.23736/S1973-9087.22.07413-5

Copyright © 2022 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC 4.0 license which allows users to distribute, remix, adapt and build upon the manuscript, as long as this is not done for commercial purposes, the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI), provides a link to the license and indicates if changes were made.

lingua: Inglese

A systematic review opens the black box of “usual care” in stroke rehabilitation control groups and finds a black hole

Chiara ARIENTI 1, Riccardo BURASCHI 1 , Joel POLLET 1, Stefano G. LAZZARINI 1, Claudio CORDANI 2, Stefano NEGRINI 2, 3, Massimiliano GOBBO 4

1 IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; 2 IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; 3 Department of Biomedical, Surgical and Dental Sciences, La Statale University, Milan, Italy; 4 Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy



INTRODUCTION: In experimental trials, new methods are tested against the “best” or “usual” care. To appraise control group (CG) interventions provided as “usual care,” we focused on stroke as a leading cause of disability demanding rehabilitation as a complex intervention.
EVIDENCE ACQUISITION: For this methodological appraisal, we conducted a systematic review of RCTs without timespan limitation. The PICO included stroke survivors, rehabilitation, control group intervention, lower limb function. To assess the risk of bias, we used the Cochrane risk of bias tool (RoB). We identified the terminology describing the CG Program (CGP), performed a knowledge synthesis and conducted a frequency analysis of provided interventions.
EVIDENCE SYNTHESIS: We included 155 publications. 13.6% of the articles did not describe the CG, and 11.6% indicated only the professionals involved. In the remaining 116 studies, three studies provided an intervention according to specific guidelines, 106 different “usual care” CGPs were detected, with nine proposed twice and two between four and five times. The most adopted terminology to state “usual care” was “conventional physiotherapy.”
CONCLUSIONS: This study shows that usual care in CG does not actually exist, as both specific terminology and consistency within CGP contents are missing. Reporting guidelines should give better assistance on this issue. These results should be verified in other fields.


KEY WORDS: Control groups; Systematic review; Stroke rehabilitation; Lower extremity

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