PurposeDespite growth in rehabilitation research, implementing research findings into rehabilitation practice has been slow. This creates inequities for patients and is an ethical issue. However, methods to investigate and facilitate evidence implementation are being developed. This paper aims to make these methods relevant and accessible for rehabilitation researchers and practitioners. MethodsRehabilitation practice is varied and complex and occurs within multilevel healthcare systems. Using a "road map" analogy, we describe how implementation concepts and theories can inform implementation strategies in rehabilitation. The roadmap involves a staged journey that considers: the nature of evidence; context for implementation; navigation tools for implementation; strategies to facilitate implementation; evaluation of implementation outcomes; and sustainability of implementation. We have developed a model to illustrate the journey, and four case studies exemplify implementation stages in rehabilitation settings. Results and ConclusionsEffective implementation strategies for the complex world of rehabilitation are urgently required.The journey we describe unpacks that complexity to provide a template for effective implementation, to facilitate translation of the growing evidence base in rehabilitation into improved patient outcomes. It emphasises the importance of understanding context and application of relevant theory, and highlights areas which should be targeted in new implementation research in rehabilitation.

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The included studies provide insufficient evidence to inform decisions about treatments specifically for eye movement disorders that occur following acquired brain injury. No information was obtained on the cost of treatment or measures of participant satisfaction relating to treatment options and effectiveness. It was possible to describe the outcome of treatment in each trial and ascertain the occurrence of adverse events.

Objective: This systematic review sought to determine the effectiveness of mental practice (MP) upon the activity limitations of the upper-limb in people after stroke, and when, in whom and how it should be delivered. Data sources: Ten electronic databases were searched from November 2009 to May 2020. Search terms included: Arm; Practice; Stroke Rehabilitation; Imagination; Paresis; Recovery of Function; Stroke Studies from a Cochrane review of MP (up to November 2009) were automatically included. The review was registered with Prospero database of systematic reviews (Reference number: CRD42019126044). Study selection: Randomised controlled trials of adults after stroke using MP for the upper-limb were included if they compared to usual care, conventional therapy or no treatment and reported activity limitations of the upper-limb as outcomes. Independent screening was carried out by two reviewers. Data extraction: One reviewer extracted data using a tool based upon the Template for Intervention Description and Replication. Data extraction was independently verified by a second reviewer. Quality was assessed using the PEDro tool.Data Synthesis: Fifteen studies (n=486) were included and 12 (n=328) underwent meta-analysis. MP demonstrated significant benefit upon upper-limb activities compared to usual treatment (standardised mean difference, SMD: 0.6, 95% 4 confidence intervals, CI: 0.32 to 0.88). Sub-group analyses demonstrated that MP appeared most effective in the first 3 months after stroke (SMD: 1.01, 95% CI: 0.53 to1.50) and in people with the most severe upper-limb deficits (weighted mean difference, WMD: 7.33; 95% CI:0.94 to 13.72). Conclusions:This review demonstrates that MP appears effective in reducing activity limitations of the upper-limb after stroke particularly in people in the first three months after stroke and in those with the most severe upper-limb dysfunction. There was no clear pattern of the ideal dosage of MP.

ObjectivesTo survey the reported content, frequency and duration of upper limb treatment provided by occupational and physiotherapists for people after stroke in the UK.DesignA cross-sectional online survey was used. Description and analysis of the data were based on items from the Template for Intervention Description and Replication (Who, Where, What and How much).SettingThe online survey was distributed via professional and social networks to UK-based therapists.ParticipantsRespondents were occupational or physiotherapists currently working clinically in the UK with people after stroke. Over the 6 week data collection period, 156 respondents opened the survey, and 154 completed it. Respondents comprised 85 physiotherapists and 69 occupational therapists.ResultsRespondents reported treating the upper limb a median of three times a week (range: 1 to 7) for a mean of 29 min (SD: 18). Most (n=110) stated this was supplemented by rehabilitation assistants, family and/or carers providing additional therapy a median of three times a week (range 1 to 7). Functional training was the most commonly reported treatment for people with mild and moderate upper limb deficits (>40%). There was much less consistency in treatments reported for people with severe upper limb deficits with less than 20% (n=28) reporting the same treatments.ConclusionsThis study provides a contemporaneous description of reported therapy in the UK for people with upper limb deficits after stroke and a detailed template to inform standard therapy interventions in future research. Several evidence-based therapies were reported to be used by respondents (eg, constraint induced movement therapy), but others were not (eg, mental imagery). The findings also highlight that the current reported provision of upper limb therapy is markedly less than what is likely to be effective. This underlines an urgent need to configure and fund services to empower therapists to deliver greater amounts of evidence-based treatment for people with upper limb deficits after stroke.