title: [Potential analyses for research on occupational therapy-led training of activities of daily living in stroke patients].
abstract: OBJECTIVE
  Every year about 200,000 people in Germany suffer from a first stroke and 65,000 persons from a recurrent stroke. Stroke is one of the major causes of acquired life-long disability. It is associated with multiple limitations in functioning, activities of daily living and social participation. People with stroke must develop and apply considerable coping and adaptation strategies to manage the consequences of disabilities in daily life. Insufficient adaptations may result in social isolation, depressive disorders, need for medical and nursing care and subsequently lead to increasing costs for care. Thus occupational therapy-led treatment addressing social participation as well as skills training, adaptation strategies and assistive technology for activities of daily living is essential for stroke patients after hospital discharge.
  Based on nine randomised comparisons, a Cochrane review from 2006 revealed that occupational therapy-led training after stroke had positive effects on personal activities of daily living (8 studies; 961 participants; 0.18 SMD; 95 % CI [0.04 to 0.32]), on extended activities of daily living (6 studies; 847 participants; 0.21 SMD; 95 % CI [0.03 to 0.39]), and on poor outcome (7 studies; 1,065 participants; odds ratio 0.67; 95 % CI [0.51 to 0.87]). However, direct implementation into the German healthcare context is not recommendable due to (1) different settings and heterogeneity within the primary studies, (2) lack of manualisation of treatment programmes and (3) insufficient evaluation of client-oriented outcomes.
  
  
  CONCLUSIONS
  It is recommended to manualise client-centred standardised modules of a stage-specific occupational therapy-led training of activities of daily living and to pilot-test this intervention programme in a feasibility study. If this trial results in a set of reliable and valid client-oriented outcome measurements applicable within the German care context and in a feasible treatment programme well accepted by stroke patients and their treating occupational therapists, a large-scaled randomised clinical trial in terms of comparative effectiveness research may follow.
authors.affiliation: Medizinische Psychologie und Medizinische Soziologie, Medizinische Fakultät, Albert-Ludwigs-Universität, Freiburg, Deutschland; Berufsakademie für Gesundheits- und Sozialwesen Saarland, Saarbrücken, Deutschland. Electronic address: christian.mueller@mps.uni-freiburg.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.affiliation: Swiss Paraplegic Research, Human Functioning Sciences, Nottwil, Schweiz.
authors.forename: Andrea
authors.initials: A
authors.lastname: Glässel
authors.affiliation: Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen, Deutschland.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Marotzki
authors.affiliation: Deutsches Cochrane Zentrum, Universitätsklinikum Freiburg, Freiburg, Deutschland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Voigt-Radloff
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D009788:Occupational Therapy / Q000379:methods*; D010351:Patient Discharge; D018802:Patient-Centered Care / Q000379:methods; D012008:Recurrence; D012656:Self-Help Devices; D012917:Social Adjustment; D000071939:Stroke Rehabilitation; D057170:Translational Research, Biomedical
keywords: Aktivtäten des täglichen Lebens; Ergotherapie; Schlaganfall; Stroke; Wissenstransfer; activities of daily living; occupational therapy; technology transfer