Abstract
Evidence suggests that a stroke occurs in isolation (no comorbid conditions) in less
than 6% of patients. Multimorbidity, compounded by psychosocial issues, makes treatment
and recovery for stroke increasingly complex. Recent research and health policy documents
called for a better understanding of the needs of this patient population, and for
the development and testing of models of care that meet their needs. A research agenda
specific to complexity is required. The primary objective of the think tank was to
identify and prioritize research questions that meet the information needs of stakeholders,
and to develop a research agenda specific to stroke rehabilitation and patient complexity.
A modified Delphi and World Café approach underpinned the think tank meeting, approaches
well recognized to foster interaction, dialogue, and collaboration between stakeholders.
Forty-three researchers, clinicians, and policymakers attended a 2-day meeting. Initial
question-generating activities resulted in 120 potential research questions. Sixteen
high-priority research questions were identified, focusing on predetermined complexity
characteristics—multimorbidity, social determinants, patient characteristics, social
supports, and system factors. The final questions are presented as a prioritized research
framework. An emergent result of this activity is the development of a complexity
and stroke rehabilitation research network. The research agenda reflects topics of
importance to stakeholders working with stroke patients with increasingly complex
care needs. This robust process resulted in a preliminary research agenda that could
provide policymakers with the evidence needed to make improvements toward better-organized
services, better coordination between settings, improved patient outcomes, and lower
system costs.
Keywords
List of abbreviations:
CPG (clinical practice guideline), RCT (randomized controlled trial)To read this article in full you will need to make a payment
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References
- Prevalence of comorbidity of chronic diseases in Australia.BMC Public Health. 2008; 8: 221
- Impact of comorbidity on ischemic stroke outcome.Acta Neurol Scand. 2006; 113: 108-113
- Comorbidity in patients after stroke: impact on functional outcome.J Rehabil Med. 2008; 40: 831-835
- Comorbidities in stroke patients as assessed with a newly developed comorbidity scale.Am J Phys Med Rehabil. 1999; 78: 416-424
- Quality of life during and after inpatient stroke rehabilitation.Stroke. 2003; 34: 801-805
- Social issues in the rehabilitation of younger stroke patients.Arch Phys Med Rehabil. 2000; 81: 205-209
- Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: implications for treatment burden.BMC Med. 2014; 12: 151
- Psychosocial Outcomes in StrokE: the POISE observational stroke study protocol.BMC Neurol. 2009; 9: 24
- Factors associated with economic cost after spontaneous intracerebral hemorrhage: a Canadian example.J Stroke. 2012; 43: e115
- Caregiver availability for severe stroke results in improved functional ability at discharge from inpatient rehabilitation.Disabil Rehabil. 2016 Dec 22; ([Epub ahead of print])
- Discharge destination of individuals with severe stroke undergoing rehabilitation: a predictive model.Disabil Rehabil. 2014; 36: 727-731
- Prevalence of multimorbidity among adults seen in family practice.Ann Fam Med. 2005; 3: 223-228
- Patterns of multimorbidity in primary care patients at high risk of future hospitalization.Popul Health Manag. 2012; 15: 119-124
- Guided care for multimorbid older adults.Gerontologist. 2007; 47: 697-704
- Rethinking health outcomes in an era of multimorbidity.Healthy Debate, Toronto2014
- When people live with multiple chronic diseases: a collaborative approach to an emerging global challenge.Andalusian Government, Seville2010
- Relationship between multimorbidity and health-related quality of life of patients in primary care.Qual Life Res. 2006; 15: 83-91
- Interventions for improving outcomes in patients with multimorbidity in primary care and community settings.Cochrane Database Syst Rev. 2012; (Available at:) (Accessed February 8, 2016): CD006560
- Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity.J Am Geriatr Soc. 2012; 60: E1-E25
- What makes stroke rehabilitation patients complex? Clinician perspectives and the role of discharge pressure.J Comorb. 2016; 6: 35-41
- Defining patient complexity from the primary care physician's perspective: a cohort study.Ann Intern Med. 2011; 155: 797-804
- Multimorbidity in primary care: developing the research agenda.Fam Pract. 2009; 26: 79-80
- Future of multimorbidity research: how should understanding of multimorbidity inform health system design?.Public Health Rev. 2010; 32: 451-474
- Multimorbidity is common to family practice: is it commonly researched?.Can Fam Physician. 2005; 51: 244-245
- Multimorbidity's research challenges and priorities from a clinical perspective: the case of ‘Mr Curran’.Eur J Gen Pract. 2014; 20: 139-147
- Children with medical complexity: an emerging population for clinical and research initiatives.Pediatrics. 2011; 127: 529-538
- Supporting children with complex health care needs and their families—an overview of the research agenda.Child Care Health Dev. 2004; 30: 195-199
- Road map to a patient-centered research agenda at the intersection of hospital medicine and geriatric medicine.J Gen Intern Med. 2014; 29: 926-931
- A scoping review and thematic classification of patient complexity: offering a unifying framework.J Comorb. 2012; 2: 1-9
- The increasing burden and complexity of multimorbidity.BMC Public Health. 2015; 15: 415
- High-cost health care users in Ontario, Canada: demographic, socio-economic, and health status characteristics.BMC Health Serv Res. 2014; 14: 532
Wodchis W. High cost users: driving value with a patient-centered health system. Presented at: Health Links and Beyond: the Long and Winding Road to Person Centered Care, June 20, 2013; Toronto, ON, Canada. Available at: http://solutionshealthcollaborative.ca/healthy-connections/healthy-connections-2013/. Accessed February 8, 2016.
- A 3-year study of high-cost users of health care.CMAJ. 2016; 188: 182-188
- Prevalence of multiple chronic conditions in the United States' Medicare population.Health Qual Life Outcomes. 2009; 7: 82
- Toward a more effective approach to stroke: Canadian Best Practice Recommendations for Stroke Care.Can Med Assoc J. 2008; 178: 1418-1425
- Effects of evidence-based clinical practice guidelines on quality of care: a systematic review.Qual Saf Health Care. 2009; 18: 385-392
- Barriers to implementation of stroke rehabilitation evidence: findings from a multi-site pilot project.Disabil Rehabil. 2012; 34: 1633-1638
- From what we know to what we do: translating stroke rehabilitation research into practice.Int J Stroke. 2013; 8: 11-17
- Guideline recommended treatments in complex patients with multimorbidity.BMJ. 2015; 351: h5145
- Current guidelines poorly address multimorbidity: pilot of the interaction matrix method.J Clin Epidemiol. 2014; 67: 1242-1250
- Consideration of multiple chronic diseases in randomized controlled trials.JAMA. 2011; 306: 2670-2672
- Stroke rehabilitation evidence and comorbidity: a systematic scoping review of randomized controlled trials.Top Stroke Rehabil. 2017; 24: 374-380
- Applying clinical practice guidelines to the complex patient: insights for practice and policy from stroke rehabilitation.Healthc Q. 2016; 19: 38-43
- Stroke rehabilitation.Lancet. 2011; 377: 1693-1702
- Another look at observational studies in rehabilitation research: going beyond the holy grail of the randomized controlled trial.Arch Phys Med Rehabil. 2005; 86: 8-15
- Health policy-makers' perceptions of their use of evidence: a systematic review.J Health Serv Res Policy. 2002; 7: 239-244
- Lost in knowledge translation: time for a map?.J Contin Educ Health Prof. 2006; 26: 13-24
- A systematic review of barriers to and facilitators of the use of evidence by policymakers.BMC Health Serv Res. 2014; 14: 2
- Research priorities in health economics and funding for palliative care: views of an international think tank.J Pain Symptom Manage. 2009; 38: 11-14
- A research agenda for helminth diseases of humans: towards control and elimination.PLoS Negl Trop Dis. 2012; 6: e1547
- The development of a research agenda for the Canadian chiropractic profession: report of the Consortium of Canadian Chiropractic Research Centres, November 2000.J Can Chiropr Assoc. 2002; 46: 86
- State of the science of postacute rehabilitation: setting a research agenda and developing an evidence base for practice and public policy. An introduction.Rehabil Nurs. 2008; 33: 82-87
- Building a research program in physical medicine and rehabilitation.Am J Phys Med Rehabil. 2009; 88: 659-666
- The revised research agenda for physical therapy.Phys Ther. 2011; 91: 165-174
- The Delphi method.Addison-Wesley, Reading1975
- The Delphi method as a research tool: an example, design considerations and applications.Inf Manage. 2004; 42: 15-29
- Consensus methods for medical and health services research.BMJ. 1995; 311: 376
Prewitt V. Working in the café: lessons in group dialogue. The Learning Organization 2011;18:189–202.
- An invitation to dialogue ‘the world café’ in social work research.Qual Soc Work. 2011; 10: 28-48
- World Café methodology engages stakeholders in designing a neonatal intensive care unit.J Neonatal Nurs. 2013; 19: 253-258
- The World Café: part one.18. World Business Academy, 2004: 1-9
- The modified Delphi technique—a rotational modification.J Career Tech Educ. 1999; 15: 50-58
- Delphi face to face. Resource papers in action research 2005.(Available at:) (Accessed January 30, 2017)
- Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review.PLoS One. 2011; 6: e20476
- The theory underlying concept maps and how to construct and use them. Florida Institute for Human and Machine Cognition.2008 (Available at: http://cmap.ihmc.us/Publications/ResearchPapers/TheoryUnderlyingConceptMaps.pdf. Accessed February 8, 2016)
- State of the science on postacute rehabilitation: setting a research agenda and developing an evidence base for practice and public policy: an introduction.J Neuroeng Rehabil. 2007; 4: 1
- Postacute rehabilitation research and policy recommendations.Arch Phys Med Rehabil. 2007; 88: 1535-1541
- Health care for older Americans with multiple chronic conditions: a research agenda.J Am Geriatr Soc. 2008; 56: 149-159
- Stroke: working toward a prioritized world agenda.Int J Stroke. 2010; 5: 238-256
- The European Statements of Hospital Pharmacy: achieving consensus using Delphi and World Café methodologies.Eur J Hosp Pharm. 2014; 21: 264-266
- Mentorship in academic medicine.John Wiley & Sons, West Sussex, UK2013
- ‘Is it worth doing?’ Measuring the impact of patient and public involvement in research.Res Involv Engagem. 2015; 1: 1
- Establishing a multicentre clinical research network: lessons learned.Curr Oncol. 2011; 18: 243-249
- Public health systems research: setting a national agenda.Am J Public Health. 2006; 96: 410-413
Article info
Publication history
Published online: September 22, 2017
Footnotes
Supported by the Canadian Institutes of Health Research (grant no. PRH-328248).
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
