Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials.
OBJECTIVE
To determine whether occupational therapy focused specifically on personal activities of daily living improves recovery for patients after stroke.


METHODS
Systematic review and meta-analysis.


METHODS
The Cochrane stroke group trials register, the Cochrane central register of controlled trials, Medline, Embase, CINAHL, PsycLIT, AMED, Wilson Social Sciences Abstracts, Science Citation Index, Social Science Citation, Arts and Humanities Citation Index, Dissertations Abstracts register, Occupational Therapy Research Index, scanning reference lists, personal communication with authors, and hand searching.


METHODS
Trials were included if they evaluated the effect of occupational therapy focused on practice of personal activities of daily living or where performance in such activities was the target of the occupational therapy intervention in a stroke population. Original data were sought from trialists. Two reviewers independently reviewed each trial for methodological quality. Disagreements were resolved by consensus.


RESULTS
Nine randomised controlled trials including 1258 participants met the inclusion criteria. Occupational therapy delivered to patients after stroke and targeted towards personal activities of daily living increased performance scores (standardised mean difference 0.18, 95% confidence interval 0.04 to 0.32, P=0.01) and reduced the risk of poor outcome (death, deterioration or dependency in personal activities of daily living) (odds ratio 0.67, 95% confidence interval 0.51 to 0.87, P=0.003). For every 100 people who received occupational therapy focused on personal activities of daily living, 11 (95% confidence interval 7 to 30) would be spared a poor outcome.


CONCLUSIONS
Occupational therapy focused on improving personal activities of daily living after stroke can improve performance and reduce the risk of deterioration in these abilities. Focused occupational therapy should be available to everyone who has had a stroke.
Legg
Lynn
L
Academic Section of Geriatric Medicine, Glasgow Royal Infirmary University NHS Trust, Glasgow G31 2ER. step@clinmed.gla.ac.uk
Drummond
Avril
A
Leonardi-Bee
Jo
J
Gladman
J R F
JR
Corr
Susan
S
Donkervoort
Mireille
M
Edmans
Judi
J
Gilbertson
Louise
L
Jongbloed
Lyn
L
Logan
Pip
P
Sackley
Catherine
C
Walker
Marion
M
Langhorne
Peter
P
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D006801:Humans; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D000071939:Stroke Rehabilitation