Occupational therapy Part III Occupational therapy for patients after stroke

Research area: Rehabilitation and occupational therapy

Duration: February 2012 - June 2012
Publication: LBI-HTA Project Report No. 59: https://eprints.aihta.at/973/

Language: German

Background:
Stroke is the third leading cause of death after cardiovascular diseases and cancer, and often leads to functional and cognitive impairment and chronic disability. Every year, about 35.000 people in Austria suffer a stroke (ICD-10: I61, I63, I64, I66). Approximately one third of the patients who survive the stroke remain dependent on their caregivers. Rehabilitation after stroke aims to reduce disability and dependency. Occupational therapy intents amongst other things to train activities of daily living with patients after stroke in order to improve their functional abilities and to increase their autonomy and quality of life.

Aim of project:
The projects aim is assessing the evidence concerning the efficacy of different occupational therapy interventions for patients after stroke. Particular attention is paid to interventions provided after discharge from inpatient (rehabilitation) setting. Content of interventions, timing, duration, and frequency (intensity) as well as information on the setting will be extracted from the included RCTs and presented in the final report.

Method:
Systematic literature search in various databases (Cochrane, CRD, Embase, Medline, OT-Seeker) will be supplemented by a non-systematic hand search.
The systematic review will use two recent Cochrane reviews (“Occupational therapy for patients with problems in activities of daily living after stroke” and “Occupational therapy for cognitive impairment in stroke patients”) as starting basis for investigation. It uses the predefined categorization of occupational therapy interventions and the search strategy and will add results of RCTs published since 2006 and 2009, respectively, to previous Cochrane results.

PICO-questions:
1) Are occupational therapy interventions with focus on activities of daily living for patients after stroke more effective concerning activities of daily living, mortality or poor outcome as well as autonomy, mood and quality of life than no intervention or routine care?
2) Are occupational therapy interventions with focus on cognitive impairment for patients after stroke with cognitive impairment more effective concerning the improvement of cognitive abilities, such as attention, memory and orientation, as well as the activities of daily living and the social and community integration than no intervention or routine care?

Inclusion criteria 1 (activities of daily living):

Population	Patients with a clinically defined stroke ?18 years
Intervention(s)	occupational therapy provided by an occupational therapist or under supervision of an occupational therapist, focused on activities of daily living
Control	no intervention routine care (including rehabilitation)
Outcomes	personal activities of daily living (pADL) mortality being physically dependent requiring institutional care mood subjective health status or quality of life carer mood carer subjective health status or quality of life patient and carer satisfaction with services
Study design	randomized controlled trials (RCTs)

Exclusion criteria 1:

• Studies of mixed aetiology where the percentage of stroke patients was less than 50%
• Studies with multi-disciplinary interventions (programs delivered by occupational therapists in collaboration with other professions e.g. physiotherapists, psychologists)
• Comparison of different therapy techniques within the same service setting or of different settings providing similar interventions
• systematic reviews, meta-analyses
• non-randomized, controlled studies and uncontrolled studies
• case-series, case reports
• expert opinion
• cost-effectiveness studies

Inclusion criteria 2 (cognitive impairment):

Population	Patients with a clinically defined stroke and confirmed cognitive impairment   ?18 years
Intervention(s)	occupational therapy provided by an occupational therapist or under supervision of an occupational therapist, focused on activities of daily living
Control	no intervention routine care (including rehabilitation)
Outcomes	basic activities of daily living, ADL instrumental ADL community integration resumption of life roles attention memory orientation executive functions general cognitive functions
Study design	randomized controlled trials (RCTs) quasi-randomized controlled trials cross-over-studies

Exclusion criteria 2:

• Studies of mixed aetiology where the percentage of stroke patients was less than 50% or if no separate data were available
• Studies which examined the effects of pharmaceutical interventions
• Studies that focused on apraxia or perceptual impairments without also containing elements of cognitive retraining
• systematic reviews, meta-analyses
• non-randomized, controlled studies and uncontrolled studies
• case-series, case reports
• expert opinion
• cost-effectiveness studies

Time schedule/ milestones:

February 2012: project protocol
March/April 2012: systematic literature search, non-systematic hand search, ordering of literature, literature selection, data extraction
May 2012: data extraction, drafting of report
June 2012: internal and external review, publication