FACILITATING CLINICAL DECISION-MAKING IN REHABILITATION: INNOVATIVE APPROACHES TO SYNTHESIZE AND TRANSLATE EVIDENCE INTO PRACTICE

Integrating scientific evidence into clinical rehabilitation practice is essential to ensuring effective, data-driven interventions. However, translating this evidence into everyday clinical decision-making presents significant challenges due to the complexity of available information and the need to personalize interventions for individual patients. This project aims to explore innovative approaches to facilitate clinical decision-making in rehabilitation, focusing on synthesizing and applying available evidence to practice. Building upon the fundamental principle that rehabilitation interventions do not directly target the disease itself but rather address impairments and activity/participation levels, as influenced by the underlying health condition, and acknowledging the lack of direct evidence on rehabilitation for post-COVID-19 condition (PCC), we developed a series of overviews of Cochrane Systematic Reviews (CSRs). These overviews employ a mapping synthesis approach, focusing on the rehabilitative management of key PCC symptoms that have been previously investigated in other health conditions. The mapping syntheses allowed the identification of high-quality evidence relevant to the rehabilitation of fatigue, post-exertional malaise, orthostatic intolerance, dyspnea, arthralgia, dysphagia, dysphonia, olfactory dysfunction, cognitive impairment, anxiety, and depression. The findings have contributed to generating valuable hypotheses for both clinical practice and future research in PCC rehabilitation. Furthermore, these insights have served as the foundation for developing treatment recommendations for PCC symptoms, as published in the World Health Organization Guidelines for clinical practice. Thereafter, we conducted a systematic review to synthesize the increasing direct evidence on rehabilitation in the context of COVID-19 and PCC, providing practical recommendations for clinicians. This review serves as a valuable resource for informing clinical decisions and promoting the adoption of evidence-based practices. Finally, we identified a series of clinical conditions of high rehabilitative interest using a Delphi method. Subsequently, after developing a new methodological framework for conducting overviews of CSRs with a mapping synthesis, we applied this methodology to one of these relevant conditions (knee replacement rehabilitation). In conclusion, evidence mapping and systematic reviews represent an innovative approach to facilitating clinical decision-making in rehabilitation. These tools support practitioners in synthesizing and applying available evidence, promoting personalized, evidence-based interventions to improve patient outcomes.