Occupational Therapy for Stroke Patients

Abstract

Background and Purpose-Occupational therapy (OT) is an important aspect of stroke rehabilitation. The objective of this study was to determine from the available literature whether OT interventions improve outcome for stroke patients. Methods-An extensive search in MEDLINE, CINAHL, EMBASE, AMED, and SCISEARCH was performed. Studies with controlled and uncontrolled designs were included. Seven intervention categories were distinguished and separately analyzed. If a quantitative approach (meta-analysis) of data analysis was not appropriate, a qualitative approach (best-evidence synthesis), based on the type of design, methodological quality, and significant findings of outcome and/or process measures, was performed. Results-Thirty-two studies were included in this review, of which 18 were randomized controlled trials. Ten randomized controlled trials had a high methodological quality. For the comprehensive OT intervention, the pooled standardized mean difference for primary activities of daily living (ADL) (0.46; CI, 0.04 to 0.88), extended ADL (0.32; CI, 0.00 to 0.64), and social participation (0.33; CI, 0.03 to 0.62) favored treatment. For the training of skills intervention, some evidence for improvement in primary ADL was found. Insufficient evidence was found to indicate that the provision of splints is effective in decreasing muscle tone. Conclusions-This review identified small but significant effect sizes for the efficacy of comprehensive OT on primary ADL, extended ADL, and social participation. These results correspond to the outcome of a systematic review of intensified rehabilitation for stroke patients. The amount of evidence with respect to specific interventions, however, is limited. More research is needed to enable evidence-based OT for stroke patients.

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

“…Subgroups of therapy-based interventions that appeared to have most impact on primary outcomes included comprehensive OT (as opposed to specific skills training) on ADL, 76 and face-to-face training groups (as compared with interventions delivered via self-paced computer-assisted training, or online through video conferencing with a therapist) on problem-solving self-efficacy. 75 Interventions targeted at improving ADL (or leisure scores) were associated with significant increases in the outcome of primary focus, but tended not to be associated with benefits in other domains.…”

“…[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).…”

“…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.…”

“…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). 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.…”

“…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.…”