Join us behind the scenes for reflections, best practices and impact stories from author teams, Geographic Groups, and others involving patients and the public in Cochrane activities.  

This month we’re doing something a little different! In celebration of our 2025 in review article, we’re sharing the full interview with Alex Todhunter-Brown. Alex is an author of the Cochrane review Physical rehabilitation approaches for the recovery of function and mobility following stroke.

Why was consumer involvement* a priority for this review?  

I don't think that this review was a particular priority for consumer involvement – I think consumer involvement is important for all reviews! There are a whole series of decisions that have to be made for all reviews; for example, at the start there are decisions about the review question, relevant population, interventions and outcomes, during the conduct of the review there are decisions about the studies that are included, the data that is extracted, and judgements of quality and risk of bias, and towards the end of the review there are decisions about key messages, presentation and dissemination of findings.

As a researcher, I don't think that I should sit alone in my office making those decisions; involving consumers to inform (or directly make) those decisions makes sense and helps me in my role as a reviewer. By involving consumers, I hope that the review becomes more relevant, accessible, useful and usable. In this particular review of physical rehabilitation for stroke, there were important questions around the definition of the intervention (what is, and what is not "physical rehabilitation"?) and around which treatments were and were not sufficiently similar to merit pooling within meta-analyses. I thought it was essential to involve consumers in answering these questions.

 

As a researcher, I don't think that I should sit alone in my office making those decisions

 

Can you remind us at what stages of the review did you involve consumers? Can you share an example where consumer input changed your approach or interpretation?

We had a group of consumers who were involved throughout, but their main involvement could be described as a "top and tail" approach. This means that the consumers were involved at the initial planning and protocol development stages, and then involved again later during the final stages of the review, when we were interpreting the findings and preparing the review for publication.  A "top and tail" approach is one of the most common approaches that there seems to be for consumer involvement. I feel that two of the most impactful changes that occurred directly as a result of consumer involvement in our review where:

1. the co-development of a new framework to describe physical rehabilitation after stroke. Consumers identified that there were important elements missing from the descriptions of physical rehabilitation treatments which had been used in previous versions of this review. The consumers helped us identify those missing elements and bring all the different components of physical rehabilitation together into a new framework. That co-produced framework was used to categorize the analyses and findings in the review.
2. new sub-group analyses that were introduced into the review. It was not an aim of ours to identify new sub-group analyses. But during the discussions some topics came up which clearly highlighted the potential importance of certain sub-group analyses when we were exploring the results. For example, while we had planned to explore the amount of physical rehabilitation delivered using sub-group analysis, the consumers told us that what they really wanted to know was whether outcomes were different if more or less than 2.5 hours/week of physical rehabilitation was delivered. This question was important to the consumers as their experience of in-patient physical rehabilitation was that it tended never to be more than 30 minutes/day, 5 days a week (an amount which falls short of the current UK guidance of 45 minutes/day).  

In your view, what impact has – or will – consumer involvement in your research have on decision-makers who use your review?

 

I think that the changes introduced as a result of consumer involvement makes our review much more clinically relevant, and therefore more easy to interpret and apply to clinical decision-making.

 

I think that the changes introduced as a result of consumer involvement makes our review much more clinically relevant, and therefore more easy to interpret and apply to clinical decision-making. The framework for describing physical rehabilitation interventions, co-developed with the consumers, informed our analyses which, in turn, provided evidence that one particular approach (neurophysiological, or 'Bobath' approach) to the delivery of physical rehabilitation might be less effective than other ways of delivering physical rehabilitation. This should mean that physical therapists cease basing their treatments on this approach, and use a mixture of different treatment components – as this is what the evidence shows is most likely to improve recovery after stroke.

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*Please note, the term “consumer involvement” is used here, as Cochrane reviews are asked to report on consumer involvement. ‘Consumers’ may include researchers, health care providers, patients and members of the public, or other professionals, such as policy makers or commissioners.