Cochrane Stroke Group 10 Years On
Progress to Date and Future Challenges
The Cochrane Collaboration1 is an international organization that aims to help people make well-informed decisions about health care by preparing, maintaining, and ensuring the accessibility of systematic reviews of the effects of health care interventions. In the early 1990s, there was clearly a need for systematic reviews in stroke,2 and so the Cochrane Stroke Group3 was set up and registered with the Cochrane Collaboration on August 1, 1993.
The goals of the Cochrane Stroke Group are as follows:
(1) Identify all randomized controlled trials and controlled clinical trials of interventions for the secondary prevention of stroke, the acute treatment and rehabilitation of stroke patients (including those with subarachnoid hemorrhage), and the organization of stroke services. To keep these reports in a Specialized Register of Trials and to ensure that it is a comprehensive and up-to-date database of reports of planned, ongoing, and completed stroke trials.
(2) Produce high-quality Cochrane reviews for publication in the Cochrane Database of Systematic Reviews, available on the Cochrane Library,4 an electronic publication available on CD-ROM or online.
(3) Ensure that published reviews are updated as new evidence becomes available.
Protocols for reviews are prepared according to strict methodological guidelines and must be accepted for publication before work on the review can begin. Protocols and completed reviews are subject to extensive and rigorous peer review before publication (full details of Cochrane methods and Stroke Group specific methods are available in the Cochrane Handbook and the Stroke Group’s Module, respectively, in the Cochrane Library).4
Progress Thus Far
Specialized Register of Trials
To find relevant trials we have searched 20 general and specialist bibliographic databases and have hand-searched 50 specialist journals and numerous conference proceedings in 6 languages. Forty-six translators from 15 countries working in 17 languages have extracted study details from 453 non-English-language trial reports. The Specialized Register currently contains more than 6750 references to more than 3005 clinical trials. (Bibliographic details of the published trials from the Specialized Register are publicly available in the Cochrane Central Register of Controlled Trials on the Cochrane Library, and can be extracted using the search term SR-STROKE.)
Members of the Cochrane Stroke Group (more than 220 individuals based in 21 countries) have contributed to the preparation of the 68 published reviews (titles are listed in the Table). The abstracts of the completed reviews are available free at the Group’s Web site (http://www.dcn.ed.ac.uk/csrg/cliblist.asp). Readers are encouraged to comment on published Cochrane reviews. (When reading a full-text review on the Cochrane Library, simply click on the Send a comment about this review link which appears in the document.) The portfolio of reviews prepared by members of the Group is now reasonably comprehensive, covering many of the major topics in stroke treatment, rehabilitation, and secondary prevention. There are, however, significant gaps, and new questions worthy of systematic reviews arise all the time.
Incorporation Into Stroke Guidelines
Information from the Cochrane Stroke Group’s systematic reviews and Specialized Register of Trials has been used to inform clinical guideline and research policy documents in the United States, Europe, and Asia. The most recent UK National Stroke Guideline states: “In each hospital, the neurologist or physician with special responsibility for stroke should review the Cochrane Library regularly.”5
Challenges for the Future
The main challenges for the future are (1) to provide more comprehensive coverage of the field; (2) to improve the quality of its published reviews (being up-to-date is a major aspect of review quality); and (3) to increase access to the Cochrane Library for health care workers and the public, especially in the developing world. (Access is already free to all in certain developed and low-income countries.)
The Cochrane Stroke Group is supported by a grant from the Chief Scientist Office of the Scottish Executive (formerly the Scottish Office) and a grant from Chest Heart and Stroke Scotland (to support reviewers’ “mini-sabbaticals” at the editorial base). We would like to thank all our contributors (too many to list here, but they are acknowledged in the Cochrane Library). If you would like to contribute to the work of the Group (by doing a new review, updating a published one, translating reports, or in some other way) please contact Hazel Fraser, Review Group Co-ordinator, firstname.lastname@example.org. Note: To mark its 10th Anniversary, the Group has established an anniversary message board at which comments, contributions, and messages can be posted. To access this board, go to http://disc.server.com/Indices/207999.html.
- Received May 15, 2003.
- Accepted May 21, 2003.
The Cochrane Collaboration. http://www.cochrane.org.
Counsell C, Warlow C, Sandercock P, Fraser H, van Gijn J. The Cochrane Collaboration Stroke Review Group. Meeting the need for systematic reviews in stroke care. Stroke. 1995; 26: 498–502.
The Cochrane Stroke Group. http://www.dcn.ed.ac.uk/csrg./
Update Software. http://www.update-software.com/cochrane.
Intercollegiate Working Party for Stroke (Update 2002) Royal College of Physicians, London 2002 (available at http://rcp.ac.uk).