title: Occupational therapy for stroke patients: a systematic review.
abstract: OBJECTIVE
  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.
authors.affiliation: Netherlands Institute for Health Care Research, PO Box 1568, 3500 BN Utrecht, The Netherlands. e.steultjens@nivel.nl
authors.forename: Esther M J
authors.initials: EM
authors.lastname: Steultjens
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.forename: Lex M
authors.initials: LM
authors.lastname: Bouter
authors.forename: Jos C M
authors.initials: JC
authors.lastname: van de Nes
authors.forename: Edith H C
authors.initials: EH
authors.lastname: Cup
authors.forename: Cornelia H M
authors.initials: CH
authors.lastname: van den Ende
mesh_terms: D000203:Activities of Daily Living; D016208:Databases, Factual / Q000706:statistics & numerical data; D006801:Humans; D007398:Interpersonal Relations; D009788:Occupational Therapy / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D000071939:Stroke Rehabilitation