Evidence-Based Approaches in Rehabilitation - Research Designs and Conceptual Foundations for Analyzing the Efficacy and Effectiveness of Rehabilitation Treatments

• Published in: Die Rehabilitation Vol. 59; no. 5; p. 303
• Main Authors: Wirtz, Markus Antonius, Schulz, Anja
• Format: Journal Article
• Language: German
• Published: Germany 01-10-2020
• Subjects: Causality; Evidence-Based Medicine; Germany; Humans; Implementation Science; Randomized Controlled Trials as Topic; Research Design; Treatment Outcome; Germany
• ISSN: 1439-1309
• DOI: 10.1055/a-1064-6587

Rehabilitation is evidenced based if treatments are applied that proved to enhance rehabilitation outcomes - generally patients' health or participation- effectively in a causal manner. Randomized control trials (RCTs) allow determining the efficacy of treatments unambiguously. If alternative research designs (e. g. case-control studies, cohort studies, observational studies) are adopted, the association of the treatment and the improvement of the health status or participation may be biased by confounding variables (limitations of internal validity). Several variants of the basic RCT designs have been developed (e. g. cluster-randomized trials, factorial designs, pragmatic trials) to adapt RCTs to the demands of practical applications. Additionally, deciding and acting evidence-based requires rehabilitation treatments and recommendations which have been developed on a solid theoretical basis and which are applied in practical rehabilitation care appropriately. Especially, because treatments have to be chosen and provided according to rehabilitation patients' individual needs. Furthermore, in every day care the application of treatments has to be matched to the specific conditions of the respective rehabilitation institution. Thus, a comprehensive understanding of evidence requires not only efficacy studies adopting RCTs. Additionally, knowledge about treatment efficacy has to be complemented by studies investigating conceptual and theoretical foundations of effective treatments (intervention design) as well as studies to apply treatments in practical rehabilitation care (implementation research) appropriately.