reducing the gap between research evidence and clinical practice , or the so - called 
 evidence - practice gap , can lead to improved patient outcomes1 and reductions in healthcare costs2 . one example of the 
 evidence - practice gap in stroke rehabilitation is the research finding that electrical 
 stimulation therapy ( es ) is effective in the treatment of upper and lower limb 
 paralysis3 . this gap is very common despite es implementation having been 
 recommended by many clinical studies5 , 6 and evidence - based clinical practice 
 guidelines in several countries7,8,9 . one proposed reason for the evidence - practice gap is the lack of a collaborative and 
 symbiotic relationship between practitioners and researchers3 . however , we do not know how often practitioners and researchers 
 collaborate in clinical studies of es for stroke . if collaboration patterns are understood 
 and improved , the evidence - practice gap may be reduced . thus , the aim of this study was to 
 investigate the degree of collaboration between practitioners and researchers through 
 research papers related to the implementation of es for stroke patients . a systematic review of the literature published before january 7 , 2015 was conducted to 
 collect data from es studies . the literature recorded in five databases ( pubmed , cochrane 
 database , pedro , otseeker , and ichushi web ) was explored for search terms related to stroke 
 and es . because of limited manpower and the difficulty in identifying papers that matched 
 the purpose of our study , manuscripts were only included if the search terms appeared in the 
 study title . the following search terms were used in this study : stroke*[ti ] or apoplexy[ti ] 
 or cerebrovascular[ti ] or vascular[ti ] or accident*[ti ] or attack[ti ] and electrical[ti ] and 
 stimulation*[ti ] . inclusion criteria were original papers that reported on es for the upper 
 or lower limbs following stroke , after the exclusion of case reports , opinions , systematic 
 reviews , protocols , letters , brain stimulation studies , and papers written in languages 
 other than english or japanese . two reviewers independently extracted data based on the criteria , and assessed the 
 collaboration patterns between practitioners and researchers based on the following 
 conditions . a practitioner was defined as a person who included a hospital as an 
 affiliation , while a researcher was identified as an individual who only belonged to a 
 research institution such as a university , college , or research center . in this study , a 
 researcher was defined as a person whose affiliation in the author s list was for a 
 university but who actually worked in a hospital at the university , because a decision 
 can not be made based on affiliation alone . the primary outcome was the prevalence of research papers that included a practitioner as 
 an author . secondary outcomes were the prevalence of research papers that included a 
 practitioner as an author or in the acknowledgements , and research papers in which the 
 practitioner was the first author . in the statistical analysis , the degree of collaboration was calculated for every year from 
 2009 to 2014 , and a time series analysis was performed on the data . the time series analysis 
 was done with jmp pro11 ( sas institute inc . , cary , north carolina ) , and white noise was 
 employed to determine the presence of a significant autocorrelation . our literature review identified 489 papers , and our final analysis included 165 papers 
 based on the selection criteria . the prevalence of papers in which a practitioner was 
 included as an author was 38.8% ( n = 64 ) , while the prevalence of papers in which a 
 practitioner was included as an author or in the acknowledgements section was 49.7% ( n = 82 , 
 table 
 1table 1.the prevalence of papers which a practitioner contributed topractitioner included as an authorpractitioner included as an author or in the 
 acknowledgementspractitioner listed as the first authorprevalence0.39 0.50 0.34 ) . a practitioner was listed as the first author in 33.9% ( n = 
 56 ) of the papers . these results indicate that the degree of collaboration between practitioners 
 and researchers was less than 50% . data for each year indicated that the prevalence of papers in which a practitioner was 
 included as an author , as an author or in the acknowledgements , and as the first author 
 remained unchanged ( table 2table 2.the collaboration patterns over the past 6 yearsprevalenceyear200920102011201220132014a0.37 0.50 0.47 0.20 0.55 0.34 b0.37 0.50 0.47 0.30 0.59 0.62 c0.42 0.21 0.21 0.50 0.32 0.41 a : the prevalence of papers in which a practitioner was included as an author . b : the 
 prevalence of papers in which a practitioner was included as an author or in the 
 acknowledgements section . c : the prevalence of papers in which a practitioner was 
 listed as the first author ) . the time series analysis revealed that there was no significant 
 autocorrelation ( p = 0.620.99 ) . therefore , the results indicate that there was no white 
 noise obscuring collaboration patterns between practitioners and researchers , and that they 
 have remained unchanged since 2009 . a : the prevalence of papers in which a practitioner was included as an author . b : the 
 prevalence of papers in which a practitioner was included as an author or in the 
 acknowledgements section . c : the prevalence of papers in which a practitioner was 
 listed as the first author in this study , a limited degree of collaboration between practitioners and researchers was 
 found in published studies employing es for stroke patients despite the fact that study 
 participants are generally recruited in hospitals . in the following discussion , two reasons 
 are suggested for the limited cooperation between practitioners and researchers , and we 
 argue the importance of collaboration . moreover , researchers who 
 have employed es for stroke have reported clinically significant findings and are thus 
 motivated to adopt es . however , once these researchers leave the clinical field , their 
 communication with practitioners is often limited . second , most practitioners do not spend 
 their free time participating in research activities . for example , our preliminary study 
 found that , if given the opportunity , less than 50% of physical therapists would spend their 
 free time participating in research activities . previous reports in other research fields have indicated that successful relationships 
 between practitioners and researchers often lead to evidence - based practices and good 
 patient treatment10,11,12 . thus , these issues were 
 resolved , practitioners would more likely implement and facilitate evidence - based 
 practices . in conclusion , more collaboration between practitioners and researchers may facilitate the 
 implementation of es , which would help close the gap between research evidence and clinical 
 practice . furthermore , this collaboration would likely result in higher levels of recovery 
 among patients with stroke .