Non-pharmacological interventions for the improvement of post-stroke activities of daily living and disability amongst older stroke survivors: A systematic review

Abstract

Globally, stroke remains a leading cause of death and disability, with older adults disproportionately affected. Numerous non-pharmacological stroke rehabilitation approaches are in use to address impairments, but their efficacy in older persons is largely unknown. This systematic review examined the evidence for such interventions as part of the Optimal Evidence-Based Non-Drug Therapies in Older Persons (ONTOP) project conducted under an European Union funded project called the Software Engine for the Assessment and Optimisation of Drug and Non-Drug Therapies in Older Persons (SENATOR) [http://www.senator-project.eu]. A Delphi panel of European geriatric experts agreed activities of daily living and disability to be of critical importance as stroke rehabilitation outcomes. A comprehensive search strategy was developed and five databases (Pubmed, CINAHL, Embase, PsycInfo and Cochrane Database of Systematic Reviews) searched for eligible systematic reviews. Primary studies meeting our criteria (non-pharmacologic interventions, involving stroke survivors aged ≥65 years, assessing activities of daily living and/or disability as outcome) were then identified from these reviews. Eligible papers were double reviewed, and due to heterogeneity, narrative analysis performed. Cochrane risk of bias and GRADE assessment tools were used to assess bias and quality of evidence, allowing us to make recommendations regarding specific non-pharmacologic rehabilitation in older stroke survivors. In total, 72 primary articles were reviewed spanning 14 types of non-pharmacological intervention. Non-pharmacological interventions based on physiotherapy and occupational therapy techniques improved activities of daily living amongst older stroke survivors. However, no evidence was found to support use of any non-pharmacological approach to benefit older stroke survivors’ disability. Evidence was limited by poor study quality and the small number of studies targeting older stroke survivors. We recommend future studies explore such interventions exclusively in older adult populations and improve methodological and outcome reporting.

Activity card sort e o repertório ocupacional de idosos: uma revisão integrativa da literatura

“…In the interventions focused on engaging in occupations, the systematic reviews by Stewart et al (2018) as the results of this review, stated that receiving occupational therapy services was strongly associated with an improvement in daily functioning poststroke, especially in activities of daily living; but in their other study, the authors declared low evidence with an impact on improving the quality of life among survivors (Stewart et al, 2019).…”

Non-pharmacological, non-surgical interventions for urinary incontinence in older persons: A systematic review of systematic reviews. The SENATOR project ONTOP series

“…Therefore, other important outcomes may have been excluded. The standardised method employed in all the ONTOP reviews ensures consistency and has already resulted in published evidence-based recommendations for nondrug management in delirium [34], falls [35,36], stroke [37], pressure sores [38,39], behavioural disturbances in dementia [40], malnutrition [41] and sarcopenia [42]. This method also has the advantage of not pre-specifying interventions in the search terms, allowing evaluation of lesser-known interventions.…”

Effectiveness of Intensively Applied Mirror Therapy in Older Patients with Post-Stroke Hemiplegia: A Preliminary Trial

“…The purpose of the MT is to perform bilateral and synchronous movements with the non-paretic limb, creating an illusion of movement in the brain [12,15,16]. Some post-stroke patients suffer from neglect syndrome, which is the inability or difficulty to detect, attend to or respond to stimuli presented contralaterally to an injured brain, in the absence of elementary sensory or motor disorders [17,18]. In motor negligence, the patient is often unable to maintain a posture for long.…”