http://stroke.ahajournals.org/content/48/11/e321?etoc=
All
people carry out a daily set of home-based activities to maintain
physical and mental health and to prepare body and mind for the next
day’s demands. These activities are referred to as activities of daily
living (ADL). The goal of occupational therapy is to improve ability to
self-care after stroke. Interventions used by occupational therapists
include assessment, treatment, adaptive techniques, assistive
technology, and environmental adaptations.
Objectives
To
assess the effects of occupational therapy interventions compared with
no intervention or standard care/practice, on the ability of adults with
stroke to self-care.
Search Methods
For
this update, we searched the Cochrane Stroke Group Trials Register
(last searched January 30, 2017), the Cochrane Controlled Trials
Register (The Cochrane Library, January 2017), MEDLINE (1946 to January
5, 2017), Embase (1974 to January 5, 2017), CINAHL (1937 to January
2017), PsycINFO (1806 to November 2, 2016), AMED (1985 to November 1,
2016), and Web of Science (1900 to January 6, 2017). We also searched
grey literature and clinical trials registers.
Selection Criteria
We
identified randomized controlled trials of an occupational therapy
intervention (compared with no intervention or standard care/practice)
where ADL was the therapeutic medium or the goal.
Data Collection and Analysis
Two
review authors independently performed study selection, data
collection, and risk of bias assessments. We also evaluated the quality
of evidence using the GRADE approach. The primary outcomes were the
proportion of participants who had deteriorated or were dependent in ADL
and performance in ADL at the end of follow-up.
Main Results
In
this update, we included 9 studies with 994 participants, comparing
ADL-focused occupational therapy with no intervention or standard
care/practice. We found low quality evidence (based on unclear risk of
selection bias and an unavoidable high risk of performance and detection
bias) that occupational therapy interventions increased ADL performance
scores (standardized mean difference, 0.17; 95% confidence interval,
0.03–0.31; P=0.02; Figure),
reduced the risk of poor outcome (death, deterioration, or dependency
in ADL; odds ratio, 0.71; 95% confidence interval, 0.52–0.96; P=0.03), and increased extended ADL scores (odds ratio, 0.22; 95% confidence interval, 0.07–0.37) P=0.005).
Occupational therapy did not influence mortality or reduce the combined
odds of death and institutionalization or death and dependency.
Occupational therapy did not improve mood or distress scores. There were
insufficient data to determine the effects of occupational therapy on
health-related quality of life. There were insufficient data to
determine carer-related outcomes or participants’ and carers’
satisfaction with services.
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