US can draw insight from other nations' experiences with evidence-based medicine

Coverage of mental health and substance misuse topics in the Cochrane review system

Aims. To assess the breadth of mental and substance coverage in the Cochrane review system. Methods. All mental health and substance entries were identified from the 2005 to April 2012 Cochrane Database of Systematic Reviews. Results. A total of 1019 entries focused on mental health or substance misuse, with 698 (68.5%) being completed reviews. One out of every five entries focused on serious mental illness/psychosis. Systematic reviews addressing unipolar depression, dementia and certain substance disorders also appeared well-represented. In contrast, a number of impairing disorders frequently seen in practice received less attention, with bipolar disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and autism spectrum disorders each accounting for less than 2% of the entries. The majority of interventions reviewed involved medication (57.1%), although this was not the case for a number of childhood-onset disorders. Some diagnostic areas (sleep, anxiety, mood and substance) were addressed by multiple Cochrane review groups (CRGs). Conclusions. The Cochrane Collaboration is well poised to be a strong guiding influence to those seeking to employ evidence-based mental health care. Broadening its diagnostic coverage and diversifying types of intervention reviewed would probably further maximize its impact. A more centralized and directed approach of prioritizing topics could help ensure more comprehensive coverage.

CER, PBE, SCIRehab, NIDRR, and other important abbreviations

Comparative effectiveness research (CER) has been receiving much attention (and government funding) in recent years, stemming from dissatisfaction with much medical and health care research, which does not produce actionable evidence that can be used by clinicians, patients, and policymakers. Rehabilitation research has been characterized by similar weaknesses and by often inadequate research designs. The SCIRehab study of the outcomes of inpatient spinal cord injury rehabilitation is one of a small number of rehabilitation practice-based evidence (PBE) studies in recent years that allows for the comparison of interventions by all disciplines for relevant real-life outcomes. This introduction to a series of articles resulting from the SCIRehab project discusses the need for and the nature of CER, and places the SCIRehab study and other PBE studies in the light of CER. After a description of the highlights of the analyses in this supplement, we provide a preliminary evaluation of SCIRehab, counting the articles and presentations from the study, the resources that went into this vast project, and the lessons learned that may benefit future rehabilitation PBE investigators.