Yes, but does it really work ??
In the late 1960s, Iain Chalmers, then a young doctor with the United Nations Relief Works Agency, was working in a maternal and child health programme. He realised that the treatments he had been trained to use in Britain often did not make his patients better and, sometimes even caused more harm than good. It was this grass roots experience that encouraged him to search for and develop treatments that were based on sound scientific evidence.
In examining the medical literature Iain discovered that the results of clinical trials were rarely incorporated into clinical practice. Perhaps this was because doctors hadn't the time to digest all the research on a particular subject. If all the results of all the trials on a particular aspect of say, stroke rehabilitation, could be condensed into one conclusion, it would be easier for practitioners and patients to tell what was effective and what was not.
Choosing the best treatments means that these must have been tested. It also means that medical, surgical, nursing and physiotherapy teams must be able to find the results quickly. Thousands of journals publish research reports every year, so finding reliable information about how best to treat each patient is a huge challenge. These reports may just describe, for example, injuries and the physical and psychological consequences. Or they may describe new treatments or equipment, or what effects treatment have for patients (what benefits they bring, and what dangers or side-effects). Reports about the effects of treatments are particularly important for decisions about how to care for patients, and a "randomised controlled trial" is thought to be the most reliable way of testing the effects of a treatment. [A "randomised controlled trial" is a trial in which subjects are randomly assigned to two groups: one (the experimental group) receiving the intervention that is being tested, and the other (the comparison group or controls) receiving an alternative treatment, a placebo or no treatment. The two groups are then followed up to see if any differences between them result. This helps people assess the effectiveness of the intervention.] Iain had read about Doctor Archie Cochrane's challenge to the medical world: "It is surely a great criticism of our profession that we have not organised a critical summary of all relevant "randomised controlled" trials".
Out of this simple idea, the Cochrane Collaboration was born. Now, health professionals, researchers and users of health services are collaborating to gather all trials on a particular aspect of healthcare and review them so that individual practitioners/patients will be able to tell which treatments are most effective. These are called "systematic reviews". Many health professionals and service users give their time free for this work. The results are regularly updated and can be accessed via the Cochrane Stroke Group website at
http://www.dcn.ed.ac.uk/csrg/
The Cochrane Collaboration, now an international network, aims to help people make well-informed decisions about all aspects of healthcare by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions.
Its work is based on certain key principles:
- Collaboration, by internally and externally fostering good communications, open decision-making and teamwork.
- Building on the enthusiasm of individuals, by involving and supporting people of different skills and backgrounds.
- Avoiding duplication, by good management and co-ordination to maximise economy of effort.
- Minimising bias, through a variety of approaches such as scientific rigour, ensuring broad participation, and avoiding conflicts of interest.
- Keeping up to date, by a commitment to ensure that Cochrane Reviews are maintained through identification and incorporation of new evidence as it emerges.
- Striving for relevance, by promoting the assessment of healthcare interventions using outcomes that matter to people making choices in health care.
- Ensuring quality, by being open and responsive to criticism, applying advances in methodology, and developing systems for quality improvement.
Over the last year Different Strokes has been contributing to the Cochrane Stroke Group and representing the "consumer" in what, up until now, has been the domain of medical "experts". The days of "the operation was successful ... but the patient died" are long gone. Today the patient's well-being is central, and the quality of his/her life post stroke can be improved by all sorts of interventions. But which of them work, and which of them have been scientifically proven to be more effective than others? The Cochrane Collaboration will keep us in the picture and future newsletters will inform you as to what emerges as the better treatments.
