SPECIAL COMMUNICATION Priorities for Stroke Rehabilitation and Research: Results of a 2003 Canadian Stroke Network Consensus Conference Mark T. Bayley, MD, FRCPC, Amanda Hurdowar, MSc, Robert Teasell, MD, FRCPC, Sharon Wood-Dauphinee, PhD, Nicol Korner-Bitensky, PhD, Carol L. Richards, PhD, Margaret Harrison, PhD, Jeffrey W. Jutai, PhD ABSTRACT. Bayley MT, Hurdowar A, Teasell R, Wood- Dauphinee S, Korner-Bitensky N, Richards CL, Harrison M, Jutai JW. Priorities for stroke rehabilitation and research: re- sults of a 2003 Canadian Stroke Network consensus conference. Arch Phys Med Rehabil 2007;88:526-8. The Canadian Stroke Network Consensus Conference panel met in 2003 in Toronto, Canada, to address areas of stroke rehabilitation that require additional research as well as in- creased efforts to knowledge translation. The results of an extensive literature review, of a study of factors related to poststroke quality of life, and a survey of clinicians were presented to the panel. From this review, the panel compiled a consensus list of 5 priority areas in stroke rehabilitation re- search that warrant further investigation. The priorities are: (1) multimodal programs for reintegration into the community; (2) rehabilitation of patients with severe strokes; (3) the ideal timing and intensity of aphasia therapy; (4) cognitive rehabil- itation; and (5) and the timing and intensity of rehabilitation after mild-to-moderate stroke. The panel recommended that agencies that fund research create special competitions to sup- port large, multicenter randomized controlled studies to inves- tigate these areas of research. In addition, the panel identified 3 priority areas for knowledge translation where research was convincing: (1) lower-extremity (leg) interventions; (2) upper- extremity (arm) interventions; and (3) detection of clients who are at risk of complications, specifically depression, dysphagia, or cognitive impairment, as well as those at risk for falls and pressure ulcers. Key Words: Consensus development conferences; Diffu- sion of innovation; Rehabilitation; Stroke. © 2007 by the American Congress of Rehabilitation Medi- cine and the American Academy of Physical Medicine and Rehabilitation O NE PROBLEM CONFRONTING the field of stroke re- habilitation is the length of time it typically takes to develop and execute a research study, to analyze its results, and to translate those results into practice. In too many cases, this process takes decades. One solution to this problem is to bring together researchers and clinicians and ask them to prioritize the areas of stroke rehabilitation that would benefit most from such studies. To this end, the Canadian Stroke Network and the Stroke Canada Optimization of Rehabilitation through Evidence (SCORE) team convened an interdisciplinary expert panel in 2003 in Toronto, Canada, to prioritize future network research and clinical topic areas that are ready for implementation into the practice of stroke rehabilitation. METHODS Consensus Panel Process The SCORE team selected a panel of researchers (n17), clinicians (n3), lay stakeholders (n3), and 1 stroke survi- vor. The panel was balanced in health professional background and area of expertise (see Acknowledgments). The SCORE team, which is a network of Canadian interdisciplinary stroke rehabilitation researchers, formed the core panel. Additionally, active researchers in stroke rehabilitation were identified through the Canadian Stroke Network and its affiliates and invited to participate as panel members. In preparation for the 2-day meeting, panel members were given summary materials that included a copy of the Stroke Rehabilitation Evidence Based Review (SREBR). 1 Prioritization Framework The panel decided that gaps in stroke rehabilitation re- search would be prioritized using the following criteria: weak current evidence, a high prevalence of the stroke-related prob- lem, and a high potential effect on health-related quality of life (HRQOL). In contrast, the panel prioritized for guideline de- velopment and for knowledge translation those areas where the research evidence on effectiveness was strong, and the poten- tial effect on stroke recovery and quality of life of consistent implementation of the evidence was also considered to be high. Data Sources Three sources of information were presented to the panel for its consideration. The SREBR. The SREBR was initiated in 2001 to system- atically review and assess the quality of randomized controlled trials (RCTs) that were directly related to stroke rehabilitation. 1 An extensive review of almost 3000 abstracts published be- tween 1968 and 2003 found approximately 500 that were related to stroke rehabilitation. Of these, 310 were RCTs and we used them for data extraction. 1 Based on the different areas of clinical care (table 1), the RCTs were categorized into 1 of 9 rehabilitation topics. We used the PEDro scale 2 to rate the From the Toronto Rehabilitation Institute (Bayley, Hurdowar) and Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto (Bayley), Toronto, ON, Canada; St. Joseph’s Health Care London and Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON, Canada (Teasell, Jutai); School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada (Wood-Dauphinee, Korner-Bitensky); Rehabilitation Department, Faculty of Medicine and Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Université Laval, Quebec City, QC, Canada (Richards); and School of Nursing, Queen’s University, Kingston, ON, Canada (Harrison). Supported by the Canadian Stroke Network. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Reprint requests to Mark T. Bayley, MD, FRCPC, Toronto Rehabilitation Institute and Division of Physical Medicine and Rehabilitation, Dept of Medicine, University of Toronto, Toronto Rehabilitation Institute, Rm 1023, 550 University Ave, Toronto, ON M5G 2A2, Canada, e-mail: Bayley.Mark@torontorehab.on.ca. 0003-9993/07/8804-11232$32.00/0 doi:10.1016/j.apmr.2007.01.005 526 Arch Phys Med Rehabil Vol 88, April 2007