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Cited by 230Stroke Rehabilitation and RecoveryOccupational Therapy Practice and ResearchDysphagia Assessment and Management

Occupational therapy for patients with problems in activities of daily living after stroke

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Legg, Lynn, Drummond, Avril, Langhorne, Peter·2006·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd003585.pub2PMC PMC6464890
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Abstract

BACKGROUND: A stroke occurs when the blood supply to part of the brain is cut off. Activities of daily living (ADL) are daily home-based activities that people carry out to maintain health and well-being. ADLs include the ability to: eat and drink unassisted, move, go to the toilet, carry out personal hygiene tasks, dress unassisted, and groom. Stroke causes impairment-related functional limitations that may result in difficulties participating in ADLs independent of supervision, direction, or physical assistance.For adults with stroke, the goal of occupational therapy is to improve their ability to carry out activities of daily living. Strategies used by occupational therapists include assessment, treatment, adaptive techniques, assistive technology, and environmental adaptations. This is an update of the Cochrane review first published in 2006. OBJECTIVES: To assess the effects of occupational therapy interventions on the functional ability of adults with stroke in the domain of activities of daily living, compared with no intervention or standard care/practice. SEARCH METHODS: For this update, we searched the Cochrane Stroke Group Trials Register (last searched 30 January 2017), the Cochrane Controlled Trials Register (The Cochrane Library, January 2017), MEDLINE (1946 to 5 January 2017), Embase (1974 to 5 January 2017), CINAHL (1937 to January 2017), PsycINFO (1806 to 2 November 2016), AMED (1985 to 1 November 2016), and Web of Science (1900 to 6 January 2017). We also searched grey literature and clinical trials registers. SELECTION CRITERIA: We identified randomised controlled trials of an occupational therapy intervention (compared with no intervention or standard care/practice) where people with stroke practiced activities of daily living, or where performance in activities of daily living was the focus of the occupational therapy intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed risk of bias, and extracted data for prespecified outcomes. The primary outcomes were the proportion of participants who had deteriorated or were dependent in personal activities of daily living and performance in activities of daily living at the end of follow-up. MAIN RESULTS: We included nine studies with 994 participants in this update. Occupational therapy targeted towards activities of daily living after stroke increased performance scores (standardised mean difference (SMD) 0.17, 95% confidence interval (CI) 0.03 to 0.31, P = 0.02; 7 studies; 749 participants; low-quality evidence) and reduced the risk of poor outcome (death, deterioration or dependency in personal activities of daily living) (odds ratio (OR) 0.71, 95% CI 0.52 to 0.96; P = 0.03; 5 studies; 771 participants; low-quality evidence). We also found that those who received occupational therapy were more independent in extended activities of daily living (OR 0.22 (95% CI 0.07 to 0.37); P = 0.005; 5 studies; 665 participants; low-quality evidence). Occupational therapy did not influence mortality (OR: 1.02 (95% CI 0.65 to 1.61); P = 0.93; 8 studies; 950 participants), or reduce the combined odds of death and institutionalisation (OR 0.89 (95% CI 0.60 to 1.32); P = 0.55; 4 studies; 671 participants), or death and dependency (OR 0.89 (95% CI 0.64 to 1.23); P = 0.47; 4 trials; 659 participants). Occupational therapy did not improve mood or distress scores (OR 0.08 (95% CI -0.09 to 0.26); P = 0.35; 4 studies; 519 participants; low-quality evidence). There were insufficient data to determine the effects of occupational therapy on health-related quality of life. We found no studies of consenting carers prior to study participation and therefore there were no carer-related outcomes in our review. There were insufficient data to determine participants' and carers' satisfaction with services.Using GRADE, the quality of evidence was low. The major limitation was the number of studies at unclear risk of selection bias and an inevitable high risk of performance and detection bias, as both participants and occupational therapists could not be blinded to the intervention. In addition, there was a sparseness of data for our outcomes of interest and we downgraded the quality of our evidence for these reasons. AUTHORS' CONCLUSIONS: We found low-quality evidence that occupational therapy targeted towards activities of daily living after stroke can improve performance in activities of daily living and reduce the risk of deterioration in these abilities. Because the included studies had methodological flaws, this research does not provide a reliable indication of the likely effect of occupational therapy for adults with stroke.

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  • Occupational therapy is an effective evidence-based intervention that positively influences stroke patients' independence recovery and quality of life.

    “Occupational therapy (OT) is an effective evidence-based intervention that positively influences stroke patients’independence recovery, leading to new opportunities for better quality of life outcomes.”

    From Early Occupational Therapy Intervention post-stroke (EOTIPS): A randomized controlled trial (2024) · cites this paper as [10]

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Authors
Legg, L., Drummond, A., & Langhorne, P.
Affiliations
  • NHS Greater Glasgow and Clyde (GB)
  • Royal Lancaster Infirmary (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
John Wiley & Sons, Ltd
Published
2006-10-18
Volume
7
Issue
4
Pages
CD003585-CD003585
ISSN
1361-6137 (ISSN-L)
DOI
10.1002/14651858.cd003585.pub2
PMC
PMC6464890
OpenAlex
W1480953160
Cited by
230
References
51
Citations by year
2026: 1 · 2025: 8 · 2024: 10 · 2023: 18 · 2022: 23 · 2021: 17 · 2020: 16 · 2019: 8 · 2018: 6 · 2017: 7 · 2016: 13 · 2015: 7 · 2014: 15 · 2013: 13 · 2012: 10
Type
reference entry
Language
en
Update notices
new_version (2017-07-19)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
Topics
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Therapy Practice and Research
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
Keywords
occupational therapy, stroke, activities of daily living, functional capacity, stroke rehabilitation, assistive technology, adaptive methods, environmental adaptation, stroke survivors, functional independence, community-based rehabilitation, home-based rehabilitation, stroke self-management, stroke prevention, stroke complications
MeSH terms
Stroke Rehabilitation, Activities of Daily Living, Humans, Occupational Therapy, Randomized Controlled Trials as Topic

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