Arrogance of the rehabilitation science in the Netherlands

Background/ Aim: In the Netherlands, a neurorehabilitation programme was established after 2006 that should be as evidence-based as possible. There is nothing wrong with that in itself, but much has not yet been researched and much is best-practice. Instead of seeking cooperation, best- practice was stripped of its roots, or on his best rather put on hold, and a new “approach ‘was created in record time.

Design: Back in history, until 2006, the knowledge network for stroke patients had been fully rolled out in the Netherlands, and all patients were treated by therapists/nurses according to the same concept. That concept was basically the Bo bath-N.D.T. concept, and perhaps that was where the problem lay.

Result: A study of questionable quality indicated that this concept had no added value compared to other treatment concepts. But the others also had no added value compared to each other, and the evidence-based approach appeared to remain at the same level. Furthermore, it turned out that the evidence-based research was not so evidence-based, because the study design was not proper and replication was not possible.

Discussion and Conclusion: It shows a considerable amount of arrogance on the part of Dutch rehabilitation science to completely undermine an existing treatment chain with essentially no evidence. On the other hand, their research was structured differently and focused mainly on the 10% who were treated in their rehabilitation centres. Their priorities apparently did not receive that attention. Now, after almost 20 years, much knowledge and expertise have been lost among the practitioners of the treatment, and the network is much smaller. So, it is high time to get everyone on the same page again and to optimally treat everyone after a stroke, while continuing to test and research that treatment.