About STEP
STEP, the Stroke Therapy Evaluation Programme, is a project designed to encourage and assist evidence-based stroke care.
A brief history of STEP
STEP was started by Professor Peter Langhorne. In 1997 Peter became particularly curious as to which specific aspects or components of the ‘black box’ of stroke unit care were effective. Peter’s vision was to create an environment where health professionals with different areas of clinical expertise were able to work co-operatively to establish a relevant, reliable, accessible, understandable evidence-base for stroke care.
STEP 1998-2001
In 1998 Chest Heart and Stroke Scotland provided 3 years of funding for a small multidisciplinary team to start STEP. During these first 3 years the STEP team had a number of key aims:
1. To produce Cochrane systematic reviews relevant to stroke care. All members of the STEP team completed at least one Cochrane systematic review and worked collaboratively with others on further reviews. This strategy started to address the lack of high quality stroke care evidence.
2. To disseminate best evidence in stroke care. A survey of barriers to achieving evidence-based stroke rehabilitation (Pollock 2000: http://www.ingentaconnect.com/content/arn/cr/2000/00000014/00000006/art00008 ) demonstrated that health professionals found it difficult to find the time to keep up to date with best evidence; and that often they lacked the ability and / or confidence to successfully integrate the results of original studies into their daily clinical practice. With this in mind, STEP launched a free quarterly newsletter: ‘S-files’. S-files attempted to promote evidence-based practice in a light-hearted and user-friendly manner. The content included summaries and appraisals of recent research, as well as helpful advice relating to the practical application of evidence-based practice in a clinical setting. The distribution of S-files was approximately 600 copies, with recipients encouraged to distribute and copy it freely. Comments, feedback and evaluation of S-files were very positive.
3. To provide training on evidence-based practice to health professionals working in stroke care. STEP held annual full-day workshops on evidence-based stroke care, and regularly presented at relevant national conferences. In addition, members of the STEP team visited, met and worked with hundreds of individuals and small local groups, to provide training in the areas, and at the level, relevant to them.
4. To contribute towards evidence-based guidelines. All members of the STEP team actively contributed towards updating and revision of the SIGN ‘Management of Patients with Stroke IV: Rehabilitation, Prevention and Management of Complication, and Discharge Planning’ Guideline (no. 63)(published in 2002).
5. Promotion of evidence-based stroke care. STEP worked hard to promote the concept of evidence-based stroke care, and the vision of multidisciplinary co-operation and collaboration, around the world.
STEP 2001-2004
Despite the success of STEP over the initial 3 year period, it was important that STEP grew into a more sustainable concept. With the increasing volume of high quality evidence in stroke rehabilitation and increasing awareness of evidence-based practice, it became apparent that the solution was to move towards a web-based project.
Chest Heart and Stroke Scotland provided funding for a one-year pilot project, which allowed for the exploration and establishment of a system for the summary, storage and retrieval of evidence. Funding by the Healthcare Foundation extended the piloting phase and eventually led to a successful funding application to NOF (‘New Opportunities Fund’, now known as ‘Big Lottery Fund’) to establish effectivestrokecare.org. (about effectivestrokecare.org)
Who is STEP?
STEP now comprises the following people:
Graham Ellis. Graham joined the STEP team in 2002. Graham is a doctor training in Stroke medicine. He contributes towards answering some of the ‘medical’ questions on effectivestrokecare.org. He works part-time on STEP and part-time doing a Cochrane review of Stroke Liaison Workers.
Peter Langhorne. Peter is Professor of Stroke Care at Glasgow University and Honorary Consultant in Geriatric Medicine at Glasgow Royal Infirmary. He is an editor for the Cochrane Stroke Group and has done several systematic reviews. He doesn’t really have enough time to contribute to effectivestrokecare.org but we couldn’t do it without him.
Lynn Legg. Lynn joined the STEP team when it started in 1998. Lynn has a background in Public Health and is a qualified but lapsed occupational therapist. Lynn has completed Cochrane Systematic Reviews on therapy based rehabilitation services for stroke patients living at home; she is also involved in reviews on Occupational Therapy for patients with ADL problems after stroke, very early mobilisation after stroke, and therapy based rehabilitation services for patients more than one year after stroke. Lynn now has the post of project leader for effectivestrokecare.org. In between managing and coordinating the effectivestrokecare.org project she also manages to contribute to the content.
Jonathan McCrea. Jonnie joined STEP in 2003. Jonnie is a physiotherapist. He completed a full-time PhD studentship in 2000 that investigated manipulations of the vertebral column for back pain and on graduating became a full time clinician. He works part-time in St John’s Hospital, Lothian NHS Trust jointly managing the domiciliary physiotherapy team with a caseload of musculoskeletal, neurological, orthopaedic, rheumatology and geriatric patients. Jonnie works part-time contributing to the evidence statements relating to the physiotherapy interventions.
Alex Pollock. Alex joined the STEP team when it started in 1998. Alex is a physiotherapist, and did her PhD looking at physiotherapy treatment approaches in patients with acute stroke; she has also done a Cochrane Systematic Review of the same topic, as well as being involved in reviews on treadmill training and electrostimulation. Alex works part-time contributing to the evidence statements relating to the physiotherapy interventions.
Cameron Sellars. Cam also joined the STEP team when it started in 1998. Cam is a speech and language therapist. He has completed a Cochrane Systematic Review into interventions for dysarthria. Cam works clinically as a speech and language therapist within Glasgow Royal Infirmary, and part-time on STEP. He contributes to the evidence statements relating to Speech and Language Therapy interventions.
Lynsey Smyth. Lynsey joined the STEP team in 2004. She is a self-confessed internet/computer geek. Lynsey provides excellent all round support to the STEP team in relation to production of content for and evaluation of effectivetrokecare.org.
What is the relationship between STEP and effectivestrokecare.org?
As outlined in the brief history of STEP, the key aim of STEP is to encourage and assist evidence-based stroke rehabilitation. STEP has come to the conclusion that the most successful method of enabling evidence-based stroke rehabilitation on an easily accessible basis is to:
· Provide systematically determined evidence-based answers to key clinical questions.
· Make this evidence accessible and easily retrievable through a web site.
This web site is effectivestrokecare.org.
Who is involved in effectivestrokecare.org?
Effectivestrokecare.org is now the primary tool used by STEP to disseminate evidence for best stroke care. The STEP team aims to create and maintain the content of the site by drawing up systematic evidence statements relating to key clinical questions. Key support is provided by IT programmers, website designers and librarians. Other organisations, such as the Cochrane Stroke Group and e-library Scotland (
http://www.elib.scot.nhs.uk/) as well as our voluntary editorial board act as advisors and expert peer reviewers and are all crucial to the success of effectivestrokecare.org.
The relationship of these different people and groups is illustrated below:
