Our projects

This page highlights our ongoing and completed projects, reflecting our collaborative efforts with global partners like the World Health Organization to improve research methodologies and bridge evidence gaps in rehabilitation, functioning, and disability.

Ongoing

Randomized controlled trial rehabilitation checklist

High-quality reporting in rehabilitation research is essential, yet research has highlighted issues such as poor replicability of randomized controlled trials and gaps in reporting standards.

To answer these needs, we launched the Randomized Controlled Trial Rehabilitation Checklist (RCTRACK) project aimed at producing a reporting guideline in rehabilitation. This checklist will report unified recommendations, including all the items needed for the production and reporting of randomized studies in rehabilitation, emphasizing functions. It aims to complement CONSORT.

According to the methodology adopted from the CONSORT Group and adapted to the EQUATOR Network suggestions, the project followed five phases.

1. Experts identified key methodological challenges in rehabilitation research at the 1st Cochrane Rehabilitation Methodological Meeting (2018, Paris, France)
2. After a scoping review of the literature, the RCTRACK project was launched at the 2nd Cochrane Rehabilitation Methodological Meeting (2019, Kobe. Japan)
3. Eight Technical Working Groups were created, and further literature reviews were carried out
4. A draft checklist was discussed at the 3rd Cochrane Rehabilitation Methodological Meeting (2020, Orlando, USA)
5. Delphi rounds refined the preliminary items. A wide range of stakeholders were asked to express their judgment about adding 16 new items to the original CONSORT and 13 additional explanations to existing CONSORT items. These aimed to add further information or contextualize the item to the rehabilitation field.  

Authors can also use GUIDE- Rehab, developed within the same project, which provides information on reporting rehabilitative interventions in randomized and non-randomized studies.  

The reporting guideline has been published in 2025, as an open-access document. 

More information on EQUATOR

Guideline for intervention description in rehabilitation (GUIDE-Rehab)

In 2023, the World Health Assembly adopted a resolution to bolster rehabilitation within health systems worldwide, underscoring the need to strengthen research efforts in the field.  

Drawing from the success of reporting guidelines like CONSORT, the focus now shifts to rehabilitation. The quality of intervention reporting in clinical trials within rehabilitation often falls short. While initiatives like the Template for Intervention Description and Replication (TIDieR) have improved reporting quality, they do not fully capture the complexity of rehabilitation interventions.

To address this gap, we developed a "Guideline for Intervention Description in Rehabilitation" (GUIDE-Rehab), to provide a comprehensive framework for describing interventions in rehabilitation studies. It follows the guidance of the EQUATOR Network, and it is registered on their website. You can find the publication here. 

Health policy and systems research in rehabilitation

Rehabilitation is essential for improving daily functioning and reducing the impact of disability on daily life. However, access to these services remains limited in many regions, despite an estimated 2.6 billion people worldwide who could benefit.

To tackle this challenge, in 2017 the World Health Organization launched the Rehabilitation 2030 initiative and, in 2023, adopted its first-ever resolution: “Strengthening Rehabilitation in Health Systems.” This calls for stronger research to guide policy and system improvements.

In response, we are leading a project, in collaboration with WHO, to synthesize evidence through four Cochrane overviews of systematic reviews focused on key pillars of health policy and systems research:

1. Delivery arrangements: Investigating how and where rehabilitation services are organized and delivered
2. Financial arrangements: Exploring funding mechanisms, insurance models, and financial incentives
3. Governance arrangements: Examining rules and processes that define authority, accountability, and oversight
4. Implementation strategies: Identifying interventions to improve the delivery and uptake of rehabilitation services

This work will help policymakers and stakeholders design strategies that improve access, quality, and outcomes for rehabilitation worldwide.

Learn more in our protocol

The first overview on Governance arrangements has been published in 2025.

Validation studies of the CochraneRehab rehabilitation definition  

In 2024, we performed a first validation study to compare how Cochrane systematic review authors describe rehabilitation interventions against criteria derived from the new rehabilitation definition, and to assess limitations or gaps in the rehabilitation definition. The study showed that the key elements of the new rehabilitation definition are almost always reported in Cochrane systematic reviews identified as rehabilitation reviews but not always consistently or clearly. However, the disability criterion was frequently unreported, while the main aim of rehabilitation is reducing disability. Also, the main elements of rehabilitation were frequently not reported. We did not find important gaps in the new definition. You can read the full paper here.

A second validation study is ongoing, in which we are analyzing a sample of Cochrane systematic reviews that had previously been identified as difficult to classify in the study by Levack et al. (2019).

Completed

Best evidence for rehabilitation (Be4rehab)

The WHO–Cochrane Rehabilitation Best Evidence for Rehabilitation (Be4Rehab) project aimed to inform the WHO Package of Interventions in Rehabilitation (PIR) by extracting data from:

• Clinical Practice Guidelines (CPGs)
• Cochrane Systematic Reviews (CSRs)

Cochrane Rehabilitation was mainly responsible for:

1. supervising the methodology of the eight Technical Working Groups (TWGs) extracting the recommendations from CPGs relevant to rehabilitation for a specific health condition
2. extracting the data from all the 245 CSRs related to 17 of the 20 health conditions included in the PIR

All eight TWGs completed their assignment. Data from 59 CPGs were extracted and information was sent to WHO-selected multi-professional panels.

The data extraction from CSRs was completed for 16 health conditions. A total of 220 reviews were assessed, 133 of these CSRs included a Summary of Findings table with evidence-quality evaluation according to GRADE system. The remaining 68 did not present a GRADE evaluation: for 48 a Summary of Findings and GRADE assessment were prepared; the remaining 20 either were empty reviews (6), focused only on secondary outcomes (2), presented only a descriptive summary (10) or were overviews (2). 

Rehabilitation definition for research purposes

Since its inception, Cochrane Rehabilitation has faced challenges with the definition of rehabilitation. Existing definitions did not indicate what rehabilitation includes and excludes.  

We wanted to develop a comprehensive and shared rehabilitation definition for research purposes to support the conduct of primary studies and systematic reviews, and identify relevant systematic reviews for knowledge translation purposes.

To achieve this, we conducted a multimodal study involving:

• seven preliminary research and discussion papers
• four Consensus Meetings, and three Delphi rounds with 80 rehabilitation stakeholders

Stakeholders covered 5 continents and included invited experts, and representatives of low middle-income countries and consumers.

We had a 70–82.5% response rate to the Delphi rounds, during which participants responded to all items (100%) and provided relevant comments (range 5.5–50% per item). This participation led to several refinements to the rehabilitation definition the final items reached an agreement between 88.9% and 100%. We structured the definition using the PICO (Population, Intervention, Comparison, Outcome) framework.

We concluded that: 

“In a health care context,” rehabilitation is defined as a “multimodal, person-centered, collaborative process” (Intervention-general), including interventions targeting a person’s “capacity (by addressing body structures, functions, and activities/participation) and/or contextual factors related to performance” (Intervention-specific) with the goal of “optimizing” the “functioning” (Outcome) of “persons with health conditions currently experiencing disability or likely to experience disability, or persons with disability” (Population).

Rehabilitation requires that all the items of the definition are satisfied. We defined a “rehabilitation intervention” as “any intervention provided within the rehabilitation process.”

This definition, developed for research purposes with global stakeholders, provides explicit criteria. Using this will improve rehabilitation research by standardizing the description of interventions. Our definition may require revision in the future, as further research enhances understanding and communication of the essence and complexity of rehabilitation. 

REH-COVER – interactive living evidence

On January 30th 2020, the WHO declared a state of emergency to combat the spread and impact of COVID-19, a disease caused by the novel virus SARS-CoV-2. To update the rehabilitation community on the growing evidence for the role of rehabilitation in the management of COVID-19 patients, Cochrane Rehabilitation launched the REH-COVER (Rehabilitation – COVID-19 Evidence-based Response) action.  

The aim of this action was to focus on the timely collection, review, and dissemination of summarized and synthesized evidence relating to COVID-19 and rehabilitation. The action was developed by an International Multi-professional Steering Committee.

REH-COVER included four main initiatives:

1. Rapid living systematic reviews on rehabilitation and COVID-19  

   The final and conclusive paper of the Cochrane Rehabilitation COVID-19 Evidence-based Response (REH-COVER) action has been published.

2. Definition of the research topics on “Rehabilitation and COVID-19” in collaboration with the WHO rehabilitation programme
3. Cochrane Library Special Collection: Coronavirus (COVID-19): rehabilitation of patients with functional consequences of acute illness and its treatments (started in June 2020 – published 4 November 2020).
4. Interactive living evidence map on rehabilitation and COVID-19  

Image

We also published a summarizing paper titled “Effectiveness of rehabilitation interventions on adults with COVID-19 and post-COVID-19 condition. A systematic review with meta-analysis”. 

Cochrane "evidence relevant to" rehabilitation of people with post COVID-19 condition

Cochrane Rehabilitation developed the REH-COVER project to provide the global rehabilitation community with the best available evidence to respond to the COVID-19 pandemic. However, currently we are also facing the long-term consequences of COVID-19, initially called “long covid” and now referred to as post COVID-19 condition.  

The WHO Rehabilitation Programme requested an evidence synthesis to support the development of specific recommendations. In response, we developed a summary of “evidence relevant to” the rehabilitation of adults with post COVID-19 condition.

The PICO framework informs evidence production and synthesis: Interventions to achieve a specific Outcome for people with a disease (Population) are contrasted with a Comparison. We could call the output of such research the “evidence on” interventions for a specific population. However, within rehabilitation, the interventions do not target the disease but the impairments and the level of activity/participation, accounting for pathology-specific contraindications.  

In other words, in rehabilitation, the health conditions contextualize the interventions that are required to regain capacity that has previously been lost by the patient. This understanding of rehabilitation provides an opportunity for a different approach to evidence gathering for new diseases — at least until direct evidence is available. Rehabilitation interventions can be identified based on their effectiveness for impairments and activity limitations in other health conditions. These interventions become strong hypotheses (and constitute the earliest evidence available) for clinical management and research until direct, more robust “evidence on” the rehabilitation for people with that health condition becomes available. This is what we call “evidence relevant to” rehabilitation.

The project provided a mapping synthesis of Cochrane systematic reviews on adults experiencing relevant post COVID-19 condition impairment. The results have been reported in five different papers in the following categories:

• fatigue, post-exertional malaise and orthostatic intolerance;
• dyspnea;
• arthralgia;
• dysphagia, dysphonia and olfactory dysfunction;
• cognitive impairment, anxiety and depression.