Specialist rehabilitation after stroke

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Abstract
But these and other overviews3 raise several issues. Firstly, if a cumulative meta-analysis of the trials had been undertaken as they were published convincing evidence of benefit would have emerged at least 10 years earlier (P Langhorne, unpublished data). Secondly, the trials used different techniques for measuring their main outcome measure, disability, which has hampered meta-analysis. Thirdly, the overviews could not examine depression and other emotional sequelae of stroke because these were rarely measured, despite their great impact on the quality of life. Any effect of stroke units on depression, although plausible, is not known and probably never will be since further trials of stroke units are unlikely to be carried out. You cannot find by analysis what was lost by design. Fourthly, we do not know what it is in the “black box” of a stroke unit that is effective because the trials did not systematically measure the interventions. Fifthly, trials using unblinded assessments of outcome probably overestimate the effect of treatments3.