Occupational therapy for cognitive impairment in stroke patients

Hoffmann, Tammy; Bennett, Sally; Koh, Chia-Lin; McKenna, Kryss

doi:10.1002/14651858.cd006430.pub2

Cited by 54 publications

(49 citation statements)

References 35 publications

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“…[70][71][72][73][74][75][76][77][78][79][80][81][82] ( Figure 7). These reviews collectively represented 101 individual RCTs, 29 of which were included in more than one review ( Table 16).…”

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

“…Full-text articles excluded (n = 79) Seven reviews explored interventions based on therapy rehabilitation, [71][72][73][74][75][76][77] though the focus of the interventions varied. Two reviews looked at interventions designed specifically for people with cognitive impairment.…”

Section: Priority Meta-review: Self-management Support For Stroke Surmentioning

confidence: 99%

“…Two reviews looked at interventions designed specifically for people with cognitive impairment. 72,75 The remaining reviews explored therapy rehabilitation generally, 71,74 or occupational therapy (OT) specifically. 73,76,77 Components relevant to our definition of self-management support in the therapy-based reviews included problem-solving; remediation training; goal-setting; information provision; support with adaptive equipment; liaison with other services; and training in activities of daily living (ADL).…”

Section: Priority Meta-review: Self-management Support For Stroke Surmentioning

confidence: 99%

“…The majority of interventions were home based and delivered to individuals on a face-to-face basis, though other models included delivery in an outpatient rehabilitation centre, or group setting. Delivery of the therapy rehabilitation was initiated soon after the acute stroke event in five reviews, [72][73][74]76,77 and later in stroke recovery (6 months to more than 1 year) in two reviews. 71,75 Outcomes were measured between 1 week and 12 months after the end of the intervention period.…”

Section: Priority Meta-review: Self-management Support For Stroke Surmentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

337

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Systematic Reviews Identifiedmentioning

confidence: 99%

Section: Priority Meta-review: Self-management Support For Stroke Surmentioning

confidence: 99%

Section: Priority Meta-review: Self-management Support For Stroke Surmentioning

confidence: 99%

Section: Priority Meta-review: Self-management Support For Stroke Surmentioning

confidence: 99%

See 2 more Smart Citations

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

337

451

View full text Add to dashboard Cite

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“…Cognitive impairment reduces the independence of the individual as it impacts performance in everyday activities such as eating, dressing, toileting, and housework [27,41]. It also negatively affects social participation and quality of life, thus it is important to treat impairment after acquired brain injury [19]. There is substantial evidence supporting therapeutic interventions regarding attention, memory, or visuo-spatial abilities [10].…”

Section: Introductionmentioning

confidence: 99%

The fun.tast.tisch. project

Augstein

Neumayr

Ruckser-Scherb

et al. 2013

Proceedings of the 2013 ACM International Conference on Interactive Tabletops and Surfaces

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Acquired brain injury, mostly caused by stroke, is one main cause for adult disability, often involving cognitive impairment. Neuro-rehabilitation aims at treating these impairments by maximizing the effect of brain plasticity and functional reorganization. Specific exercises help patients to regain skills that have temporarily been lost. Yet, conventional training can involve disadvantages, e.g., the setup of an individual training environment causes a lot of effort, the computation of statistics is time-consuming and must be done by therapists manually, and it is usually not possible to discreetly adapt the level of difficulty of an exercise. Further, software solutions for desktop PCs often do not lead to the desirable results because they are too distinct from the conventional therapy setting. The fun.tast.tisch. project introduces a tabletop-based training system for the application in neuro-rehabilitation. This system should not only come close to the conventional setting but also overcome problems involved in existing solutions. The paper introduces the project, describes its first module Tangram, and summarizes the results of a small-scale study conducted to evaluate the module with the help of therapists and patients at an early stage of development.

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Multi-disciplinary rehabilitation for acquired brain injury in adults of working age

Turner-Stokes

Pick

Nair

et al. 2015

Cochrane Database of Systematic Reviews

232

130

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Problems following ABI vary. Consequently, different interventions and combinations of interventions are required to meet the needs of patients with different problems. Patients who present acutely to hospital with mild brain injury benefit from follow-up and appropriate information and advice. Those with moderate to severe brain injury benefit from routine follow-up so their needs for rehabilitation can be assessed. Intensive intervention appears to lead to earlier gains, and earlier intervention whilst still in emergency and acute care has been supported by limited evidence. The balance between intensity and cost-effectiveness has yet to be determined. Patients discharged from in-patient rehabilitation benefit from access to out-patient or community-based services appropriate to their needs. Group-based rehabilitation in a therapeutic milieu (where patients undergo neuropsychological rehabilitation in a therapeutic environment with a peer group of individuals facing similar challenges) represents an effective approach for patients requiring neuropsychological rehabilitation following severe brain injury. Not all questions in rehabilitation can be addressed by randomised controlled trials or other experimental approaches. For example, trial-based literature does not tell us which treatments work best for which patients over the long term, and which models of service represent value for money in the context of life-long care. In the future, such questions will need to be considered alongside practice-based evidence gathered from large systematic longitudinal cohort studies conducted in the context of routine clinical practice.

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Occupational therapy for cognitive impairment in stroke patients

Cited by 54 publications

References 35 publications

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

The fun.tast.tisch. project

Multi-disciplinary rehabilitation for acquired brain injury in adults of working age

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