A systematic review opens the black box of "usual care" in stroke rehabilitation control groups and finds a black hole.
Chiara Arienti, Riccardo Buraschi, Joel Pollet and 4 others
PMID 35634889WHAT IT FOUND
Stroke lower-limb trials rarely defined usual care.
Only three of 155 studies said their control program followed specific guidelines, and 39 articles did not specify usual care. Check what the control group actually received before trusting a new treatment's benefit.
Key findings
01Only three of 155 included studies reported a control program based on specific stroke rehabilitation guidelines.
02In 39 articles (25.2%), the contents of usual care were not specified.
03Among 116 papers that specified control interventions, 106 different usual-care programs were detected, and 89 programs appeared only once.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review focused only on stroke lower-limb trials, so it may not describe usual care in other rehabilitation areas. Only English-language papers were included, so usual-care reporting in other languages was missed. The review did not assess whether the usual-care components were effective, so it cannot say whether any control program was better or worse. Many included trials had unclear risk of bias because they did not report randomization, allocation concealment, blinding, dropout handling, or protocol registration. The included studies often described control-group interventions poorly, which limits how far the results can be applied to clinic.
The easy way to misread this
Do not treat usual care in these stroke lower-limb trials as a standard benchmark. Only three of 155 control programs were described as following specific guidelines, and 39 articles did not specify the contents.