Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials

doi:10.1136/bmj.39343.466863.55

BMJ 2007;335:922 (3 November), doi:10.1136/bmj.39343.466863.55 (published 27 September 2007)

Research

Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials

Lynn Legg, CSO research training fellow¹, Avril Drummond, principal research fellow in rehabilitation³, Jo Leonardi-Bee, lecturer in medical statistics², J R F Gladman, professor of medicine of older people³, Susan Corr, reader in occupational science⁴, Mireille Donkervoort, senior researcher department of rehabilitation medicine⁵, Judi Edmans, research occupational therapist³, Louise Gilbertson, clinical specialist occupational therapist in stroke⁶, Lyn Jongbloed, associate professor⁷, Pip Logan, principal research fellow³, Catherine Sackley, professor of physiotherapy research⁸, Marion Walker, associate professor and reader in stroke rehabilitation and associate director UK stroke research network³, Peter Langhorne, professor of stroke care¹

¹ Academic Section of Geriatric Medicine, Glasgow Royal Infirmary University NHS Trust, Glasgow G31 2ER, ² Division of Epidemiology and Public Health, Clinical Sciences Building, City Hospital Campus NHS Trust, Nottingham NG5 1PB, ³ Division of Rehabilitation and Ageing, Medical School, Queen's Medical Centre, Nottingham, ⁴ Division of Occupational Therapy, School of Health, University of Northampton, Northampton NN2 7AL, ⁵ Erasmus University Medical Centre, Postbus 2040, 3000 CA, Rotterdam, Netherlands, ⁶ Occupational Therapy Service, Royal Haslar Hospital, Gosport PO12 2AA, ⁷ Department of Occupational Science And Occupational Therapy, UBC School of Rehabilitation Sciences, Online Programs, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5, ⁸ Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT

Correspondence to: L Legg step{at}clinmed.gla.ac.uk

Objective To determine whether occupational therapy focusedspecifically on personal activities of daily living improvesrecovery for patients after stroke.

Design Systematic review and meta-analysis.

Data sources The Cochrane stroke group trials register, theCochrane central register of controlled trials, Medline, Embase,CINAHL, PsycLIT, AMED, Wilson Social Sciences Abstracts, ScienceCitation Index, Social Science Citation, Arts and HumanitiesCitation Index, Dissertations Abstracts register, OccupationalTherapy Research Index, scanning reference lists, personal communicationwith authors, and hand searching.

Review methods Trials were included if they evaluated the effectof occupational therapy focused on practice of personal activitiesof daily living or where performance in such activities wasthe target of the occupational therapy intervention in a strokepopulation. Original data were sought from trialists. Two reviewersindependently reviewed each trial for methodological quality.Disagreements were resolved by consensus.

Results Nine randomised controlled trials including 1258 participantsmet the inclusion criteria. Occupational therapy delivered topatients after stroke and targeted towards personal activitiesof daily living increased performance scores (standardised meandifference 0.18, 95% confidence interval 0.04 to 0.32, P=0.01)and reduced the risk of poor outcome (death, deterioration ordependency in personal activities of daily living) (odds ratio0.67, 95% confidence interval 0.51 to 0.87, P=0.003). For every100 people who received occupational therapy focused on personalactivities of daily living, 11 (95% confidence interval 7 to30) would be spared a poor outcome.

Conclusions Occupational therapy focused on improving personalactivities of daily living after stroke can improve performanceand reduce the risk of deterioration in these abilities. Focusedoccupational therapy should be available to everyone who hashad a stroke.

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