title: Systematic review of leisure therapy and its effectiveness in managing functional outcomes in stroke rehabilitation.
abstract: BACKGROUND
  Evidence suggests that the incorporation of leisure activities in adult stroke rehabilitation can contribute to improved physical, cognitive, and psychological outcomes. However, differences in study design and treatment delivery may affect these findings. Furthermore, the magnitude of therapeutic change associated with leisure therapy is unclear, with few quantitative reviews available.
  
  
  OBJECTIVE
  To synthesize and evaluate the empirical evidence examining leisure therapy in stroke rehabilitation.
  
  
  METHODS
  Eight independent studies (N = 615 participants) were identified from a comprehensive database search. Study quality was evaluated using the Oxford Levels of Evidence. Pre- and posttreatment data for participants who received leisure therapy, in comparison with peers who received standard care or no treatment, were evaluated by calculating Cohen's d effect sizes and 95% confidence intervals.
  
  
  RESULTS
  No studies met the criteria for the highest level of methodological rigor, although all used randomization procedures. Leisure therapy contributed to significant short-term improvements in psychological outcomes, namely quality of life and mood (d range, 2.10 to 0.54), in addition to leisure-specific outcomes, including increased participation in and satisfaction with leisure activities (d range, 0.81 to 1.23). Longer term effects of treatment could not be determined, with one study providing data and reporting nonsignificant effects (d range, -0.07 to 0.17).
  
  
  CONCLUSIONS
  There is some evidence that leisure therapy offers an opportunity to enhance short-term treatment gains in community-based stroke rehabilitation. Further controlled research is needed to establish its longer term effects and assist the development of evidence-based guidelines for this treatment.
authors: School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.
authors: D
authors: D
authors: Dorstyn
authors: School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.
authors: R
authors: R
authors: Roberts
authors: School of Social Sciences and Psychology, University of Western Sydney, Penrith, New South Wales, Australia.
authors: I
authors: I
authors: Kneebone
authors: Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, United Kingdom.
authors: P
authors: P
authors: Kennedy
authors: Hampstead Rehabilitation Centre, Northfield, South Australia, Australia.
authors: C
authors: C
authors: Lieu
mesh_terms: D000203:Activities of Daily Living; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008297:Male; D012064:Relaxation Therapy / Q000379:methods*; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
keywords: leisure activities; occupational therapy; recreation therapy; rehabilitation; stroke; systematic review; treatment outcome