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Was this activity helpful to you for learning conditions and impact on occupational performance?

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Was this activity helpful to you for learning conditions and impact on occupational performance?

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Overall, our group found this activity very helpful. The activity was helpful in finding interventions that were evidence-based that we can use in future practice. We found it very interesting that everything we had been learning about actually had real backing and science to it. Not only did it help us with finding evidence-based intervention, but the padlet helped us further understand what we have been reading about and learning this whole semester. It provided us with other sources to back our understanding and learning. Seeing the same information in a variety of ways helped us take in the information and store it more effectively. It also helped us to find various resources that we could use for our conditions worksheet. Lastly, this activity further supported our abilities to look into the literature and pull out what is essential and valuable, which is highly beneficial in using evidence-based practice to guide our clinical reasoning.

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What resource stands out to the group as most interesting or one that provides very meaningful information? 

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What resource stands out to the group as most interesting or one that provides very meaningful information? 

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The resources found within the group that were the most interesting consisted of the articles on burn injuries and traumatic brain injuries. These articles provided meaningful information on occupation-based interventions to enhance the quality of life and participation in daily activities that are meaningful to the client. Therapeutic use of self is important to consider when interacting with a client that is experiencing pain or discomfort due to their injuries. As occupational therapists, there needs to be empathy and understanding of the hardships these clients face throughout the day. Clients need support and trust in order to feel safe throughout every session.

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Briefly describe any challenges you encountered finding resources for the conditions

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Briefly describe any challenges you encountered finding resources for the conditions

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The condition padlet was a great way to see how occupational therapy is used with different conditions. As a group, we did find it difficult to locate evidence-based articles; we saw more case studies than anything else. While looking for different resources, we found it difficult to locate articles that were occupation-based. Many articles gave us the pathology of the condition but were not related to occupation. We also had trouble finding articles that have been published in the last five years. Many of our articles were from 1985–2004. This made it hard to establish if these interventions are still used in practice today. The hardest condition to find research on was HIV. Occupational therapy seems to not have been used as much with this condition compared to the others listed.

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Chronic Obstructive Pulmonary Disease and Engagement in Occupation

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Chronic Obstructive Pulmonary Disease and Engagement in Occupation

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Chan, S. C. C. (2004). Chronic Obstructive Pulmonary Disease and Engagement in Occupation. The American Journal of Occupational Therapy, 58(4), 408–415. https://doi.org/10.5014/ajot.58.4.408

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Smallfield, S., Fang, L., & Kyler, D. (2021). Self-management interventions to improve activities of daily living and rest and sleep for adults with chronic conditions: A systematic review. The American Journal of Occupational Therapy, 75(4). https://doi.org/10.5014/ajot.2021.046946

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Multicontextual occupational therapy intervention: A case study of Traumatic Brain Injury

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Multicontextual occupational therapy intervention: A case study of Traumatic Brain Injury

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Landa-Gonzalez, B. (2001). Multicontextual occupational therapy: A case study of traumatic brain injury. Occupational Therapy International, 8(1), 49-62. https://doi.org/10.1002/oti.131

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

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

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

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Legg, L. A., Lewis, S. R., Schofield-Robinson, O. J., Drummond, A., & Langhorne, P. (2017).Occupational therapy for adults with problems in activities of daily living after stroke. The Cochrane database of systematic reviews, 7(7). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483548/

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Monitoring Editor: Lynn A Legg, Sharon R Lewis, Oliver J Schofield‐Robinson, Avril Drummond, Peter Langhorne, and Cochrane Stroke Group

NHS Greater Glasgow and Clyde Health Board, Royal Alexandra Hospital, PaisleyUK, PA2 9PN

Royal Lancaster Infirmary, Patient Safety Research Department, Pointer Court 1, Ashton Road, LancasterUK, LA1 4RP

Royal Lancaster Infirmary, University Hospitals of Morecambe Bay, NHS, Research and Development, LancasterUK, LA1 4RP

University of Nottingham, Faculty of Medicine and Health Sciences, QMC Campus, NottinghamNG7 2HAUK

ICAMS, University of Glasgow, Academic Section of Geriatric Medicine, Level 2, New Lister Building, Glasgow Royal Infirmary, GlasgowUK, G31 2ER

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.

Occupational therapy for adults with problems in activities of daily living after stroke
Review question
What are the effects of occupational therapy for adults with stroke on activities of daily living?

Background
Different parts of the brain carry out different functions: seeing, sensation, balance, movement, understanding language, behaviour, problem solving, and emotion. A stroke occurs when the blood supply to part of the brain is cut off. If the blood supply is cut off to a part of the brain that carries out a particular function (such as seeing, moving arms and legs, or speaking), then these body parts or body functions will not work as they should.

Activities of daily living (ADLs) are daily household‐based activities that people carry out to maintain health and well‐being. ADLs include eating and drinking, moving about, going to the toilet, personal hygiene, dressing and undressing, and grooming. When stroke changes how body parts or functions work, then the ability to carry out ADLs can become affected.

For adults with stroke, the goal of occupational therapy is to improve ability to carry out ADLs. Strategies used by occupational therapists include activity‐based interventions, adaptive techniques, assistive technology, and environmental adaptations.

Study characteristics
We found nine studies up to January 2017, involving 994 participants, that looked at the benefits of occupational therapy interventions for adults with stroke who had problems with activities of daily living. This is an update of the Cochrane review first published in 2006.

Key result
We found that occupational therapy for people with stroke can improve their ability to carry out these daily activities and stop them deteriorating in those abilities. We found no evidence that occupational therapy reduced rates of death or the need to be cared for in an institution, or affected mood or distress of the participant. We did not collect data on carer‐related outcomes or participant satisfaction with the service.

Quality of the evidence
There were few studies measuring our outcomes of interest and we judged the quality of the evidence to be of low‐quality. Many of the studies did not report methods sufficiently clearly and it was not possible to mask the occupational therapy from the person giving or receiving the treatment; this could also have influenced the results in our studies. We did not have sufficient good‐quality evidence to be certain of our results and we cannot be certain that future studies will not change these conclusions.

Description of the condition

Stroke is the death of brain tissue as a result of an interruption of the blood flow leading to or within the brain, or by an aneurysm or ruptured blood vessel in the brain. Activities of daily living (ADLs) are normal day‐to‐day household‐based tasks and activities that people carry out to maintain health and well‐being. ADLs include eating and drinking, moving about (such as getting into and out of bed, turning over in bed, getting on and off a chair, moving between rooms, moving between levels (using stairs)), going to the toilet (including carrying out toilet hygiene), carrying out personal hygiene tasks (including washing hair and body, and drying oneself), getting dressed and undressed, and grooming activities (including performing oral hygiene activities, combing hair, shaving). Stroke causes impairment‐related functional limitations that may result in difficulties carrying out ADLs independent of supervision, direction, or physical assistance.

Description of the intervention

For adults with stroke, the goal of occupational therapy is to improve the ability to carry out activities of daily living. Strategies used by occupational therapists include assessment, treatment, adaptive techniques, assistive technology, and environmental adaptations.

How the intervention might work

The central aspects (or core components) of occupational therapy for adults with stroke include the following.

Assessment

Assessment allows occupational therapists to gather important information about the adult with stroke and the difficulties they are facing. The purpose of assessment is to:

determine the impact of stroke‐related changes in body structures and body functions on the adult's skills, capacities, and abilities to independently initiate, sustain, and complete actions and tasks necessary to carry out activities of daily living (i.e. stroke‐related impairment‐related functional limitations) ( Gillen 2016a; ICF 2001; OTfPD 2008a).

identify the adult with stroke's perceived problems and priorities and to prioritise main concerns.

learn about stroke‐related impairment‐related functional limitations by observing the adult with stroke carrying out meaningful tasks, such as getting dressed or eating ( Gillen 2016e; OTfPD 2008e).

All assessments are used to analyse how the adult with stroke completes activities of daily living, the results of which are used to create a therapy plan.

Partnership

Occupational therapists work in partnership with adults with stroke and make joint decisions about what therapeutic interventions and individual goals are appropriate and relevant ( OTfPD 2008c).

Programme plan

There is a programme plan for each adult with stroke and this plan includes all activities necessary to achieve clinical recovery and performance improvement for that given individual ( OTfPD 2008c).

The programme plan includes detailed specifications of individual short‐term and long‐term goals, and treatment approaches and methods to be employed to achieve the goals. The nature and definition of individual goals is a shared decision between the adult with stroke and occupational therapist and is based on the self‐determined needs and preferences of the adult with stroke combined with the best available information from assessments, current best scientific information, and clinical judgement ( OTfPD 2008c).

Occupational therapy treatment approaches and methods are selected based on intentionality, appropriateness, and resources available ( OTfPD 2008b). Short‐term and long‐term goals are the stages into which the programme is divided for monitoring, and evaluation and measurement of the impact of therapy ( OTfPD 2008c).

Incremental and progressive

Interventions targeted towards clinical recovery are designed to be progressive with incremental increases in activity and difficulty levels ( OTfPD 2008e).

Active engagement in authentic practice

Interventions are designed to engage the adult with stroke in authentic practice of actions, activities, and interactions ( OTfPD 2008d; Gillen 2016b; Gillen 2016c).

Enduring and applicable

Interventions are designed to promote therapy generalisation and long‐term maintenance of therapeutic change by empowering stroke patients ( Gillen 2016c).

Evaluation and accountability

Intervention effectiveness is evaluated continuously by both the occupational therapist and stroke patient. The occupational therapist assumes accountability for achieving outcomes ( Gillen 2016a; OTfPD 2008b; OTfPD 2008c).

Why it is important to do this review

As mortality rates from stroke continue to improve, so do the odds that several generations of stroke survivors are alive at the same time. Many stroke survivors have marked limitations in ability to perform routine ADLs as a result of stroke‐related physical or mental impairment. As a consequence, many stroke survivors require some form of long‐term care, which includes unpaid care (provided by family and friends), government or funded personal care services, assisted living, and residential or nursing care. The significant costs associated with providing this support is likely to be borne by families and society.

Occupational therapy aims to help people reach and maintain their maximum level of function and self‐reliance in ADL.

The original Cochrane review ( Legg 2006), including eight studies involving 1258 participants, found that occupational therapy interventions reduced the odds of a poor outcome (dependency or deterioration) and increased personal ADL scores. This is an update of the original review. A GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) approach was not used to assess the quality of the evidence in the original review.

Criteria for considering studies for this review

Types of studies

We sought all randomised controlled trials (RCTs) of adults with stroke receiving an intervention provided by an occupational therapist, or under the supervision of an occupational therapist, with the specific aim of improving functional capacity or performance in activities of daily living (ADL) compared with no intervention or standard care/practice. We excluded studies which compared different types of occupational therapy intervention. We included randomised cross‐over studies.

Types of participants

We included trials that recruited adults (aged 18 years and above) who met a clinical definition of stroke (focal neurological deficit caused by cerebrovascular disease).

We excluded trials of mixed aetiology where the percentage of adults with stroke was less than 50%. We also excluded trials that only included adults with specific stroke‐related impairments (i.e. neuromusculoskeletal and movement‐related impairments, or changes in muscle power, or mental impairment, or sensory impairment, or voice and speech function impairment).

Types of interventions

We included trials of occupational therapy interventions, which had the following features.

Described as an occupational therapy intervention.

Delivered by an occupational therapist or under the supervision of an occupational therapist.

Focused on activities of daily living (ADL), which are eating and drinking, functional mobility, going to the toilet, dressing, carrying out personal hygiene (including washing body, bathing/showering), grooming (including oral hygiene) ( Gillen 2016d).

Occupational therapy interventions fell under one or more of the following categories:

treatments focused on remediating impaired capacities or abilities in the context of ADLs ( OTfPD 2008c) such as task‐orientated approaches ( Gillen 2016b) or activity‐based interventions ( Gillen 2016d);

the use of adaptive (compensatory) techniques as an alternative way to effectively complete ADLs ( OTfPD 2008c);

the use of assistive technology (AT) in which the adult with stroke has the use of any item, piece of equipment, or product system to increase, maintain, or improve their functional capacity ( ATiA); or

environmental adaptations in which the participant's physical environment is modified with ramps, electric hoists, stair lifts, handrails, level access, or wet‐room wheelchair accessible shower ( Age UK 2017) in order to restore or enable self‐reliance, privacy, confidence, or dignity for the adult with stroke.

We included trials in which the control group received no intervention or standard care/practice.

We excluded trials:

of occupational therapy interventions delivered to adults with stroke in care or nursing homes, as this is covered in a separate review ( Fletcher‐Smith 2013);

comparing occupational therapy interventions being delivered in different settings, e.g. occupational therapy in clinic versus occupational therapy at home;

that included occupational therapists as part of a multidisciplinary team as they are or will be covered in other reviews and therefore are beyond the remit of this review;

that included occupational therapy interventions in combination with other interventions, for example, occupational therapy and brain stimulation;

testing specific treatment approaches, e.g. task‐specific training or cognitive training.

If multi‐arm studies included more than one intervention performed by an occupational therapist, we selected the intervention arm that was most closely related to our review objectives ( Higgins 2011c).

Types of outcome measures

We were interested in outcomes that assessed whether occupational therapy improves activities in daily living (ADL), as reflected in our primary outcomes. We collected data which were reported and measured by study authors using appropriate measurement tools, at the end of scheduled study follow‐up.

We required that study authors reported that unpaid carers had provided consent prior to study participation for inclusion of carer‐related outcomes in our review.

Primary outcomes

Performance in personal ADL at the end of scheduled follow‐up. Measures of ADL included Barthel Index or Functional Independence Measure (FIM).

Death or a poor outcome at the end of follow‐up*. We defined this as the combined outcome of being dead or:

having deteriorated, characterised by experiencing a deterioration in ability to perform personal activities of daily living (i.e. experiencing a drop in ADL score); or

being dependent, characterised by lying above or below a predefined cut‐off point on a given ADL scale; or

requiring institutional care at the end of scheduled follow‐up.

* The primary outcome 'Death or a poor outcome' is a composite outcome with some components appearing as secondary outcomes.

Secondary outcomes

Death at the end of scheduled follow‐up.

Number of participants dead or physically dependent at the end of scheduled follow‐up.

Number of participants dead or requiring institutional care at the end of scheduled follow‐up.

Performance in extended activities of daily living (EADL) (community and domestic activities) at the end of scheduled follow‐up. Measure of EADL included Frenchay Activities Index or Nottingham Extended ADL.

Participant mood at the end of scheduled follow‐up. Measures of mood included Beck Depression Inventory, or Hospital Anxiety and Depression Scale.

Participant health‐related quality of life (HRQOL) at the end of scheduled follow‐up. Measures included EuroQOL, or Nottingham Health Profile.

Carer mood at the end of scheduled follow‐up. Measures included Beck Depression Inventory, or Hospital Anxiety and Depression Scale.

Carer health‐related quality of life at the end of scheduled follow‐up. Measures included EuroQOL, or Nottingham Health Profile.

Participant and carer satisfaction with services.

Search methods for identification of studies

See the 'Specialized register' section in the Cochrane Stroke Group module. We attempted to identify all relevant trials, regardless of language or publication status, and arranged translation of relevant papers, where necessary.

Electronic searches

For this update we searched the following:

Cochrane Stroke Group Trials Register (searched 31 January 2017);

Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1) in the Cochrane Library (searched 11 January 2017) ( Appendix 1);

MEDLINE Ovid (1946 to 5 January 2017) ( Appendix 2);

Embase Ovid (1974 to 5 January 2017) ( Appendix 3);

CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 5 January 2017) ( Appendix 4);

PsycINFO Ovid (1806 to 2 November 2016) ( Appendix 5);

AMED Ovid (The Allied and Complementary Medicine Database; 1985 to 1 November 2016) ( Appendix 6);

Web of Science (limited to Science Citation Index Expanded, Social Sciences Citation Index, Conference Proceedings Citation Index ‐ Science, and Conference Proceedings Citation Index ‐ Social Science & Humanities; 1900 to 6 January 2017) ( Appendix 7);

OpenGrey (System for Information on Grey Literature in Europe; http://www.opengrey.eu; 1980 to January 2017) ( Appendix 8).

We developed the MEDLINE search strategy ( Appendix 2), which included controlled vocabulary and free‐text terms, with the help of the Stroke Group's Cochrane Information Specialist (Joshua Cheyne) and adapted this for the other databases. Where appropriate, they were combined with subject strategy adaptations and modifications of the highly sensitive search strategy, designed by the Cochrane Collaboration for identifying randomised controlled trials and controlled clinical trials (as described in Higgins 2011a Chapter 6). Where necessary, we updated our search terms by adding relevant new database controlled vocabulary terms.

We also searched the following trials registries.

US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (clinicaltrials.gov; searched 31 January 2017) ( Appendix 9);

World Health Organization Clinical Trials Registry Platform (app.who.int/trialsearch; searched 31 January 2017) ( Appendix 9).

Evidence for this review included search results from the previous version of this review ( Legg 2006) combined with results from the above searches. In Legg 2006, there were no date limits and searches were applied from inception of databases.

Databases searched in addition to the above, and other differences in searches since the previous review, are reported in Differences between protocol and review.

Searching other resources

We searched the reference lists of papers reporting studies selected for inclusion in this review in order to identify additional relevant trials.

Data collection and analysis

Data extraction and management

Two of three review authors (LL, PL, SL) independently extracted data from published reports using a standard data recording form. Where differences occurred between investigators, we resolved these through discussion. We contacted the study authors of three studies to request additional information. We did not contact all trialists, as had been the intention in the original review ( Legg 2006).

In studies where a cross‐over design was used, we only extracted data from the first treatment phase after randomisation.

Assessment of risk of bias in included studies

We assessed risk of bias using the Cochrane 'Risk of bias' tool ( Higgins 2011b). We assessed the methods used in each study to control for the following potential sources of bias: sequence generation (selection bias); allocation concealment (selection bias); blinding of participants, personnel and outcome assessors (performance and detection bias); incomplete outcome data (attrition bias); selective outcome reporting (reporting bias); and other sources of bias.

It was not feasible to blind participants and personnel to the intervention and therefore we agreed to judge all outcomes as having a high risk of performance bias. For detection bias, we considered this by outcome. We judged that all outcomes relating to death were unlikely to be influenced by lack of blinding of outcome assessors and, even if outcome assessors for death were described as not blinded, we judged this bias to be low risk. For detection bias relating to all other outcomes, we considered three aspects from the information presented in the paper: whether the tool that was used to assess the outcome used observation, interview or self‐completion (e.g. questionnaire); whether the assessment was made by the participant or an assessor; and whether the assessor was blinded. If the assessment tool involved self‐assessment by the participant, we judged detection bias to be unclear because the participant could not be blinded to the intervention and we did not know if lack of blinding would influence participant responses to self‐assessment ( Higgins 2011b). If the assessment tool was used by an independent assessor and only included observation, we judged detection bias to be low. Where assessment was mixed either by type of assessor, type of tool, or type of outcome, we judged detection bias to be unclear.

For the purpose of this review, a true intention‐to‐treat analysis was defined as following three principles: 1) participants were kept in the intervention groups to which they were randomised, regardless of the intervention they actually received; 2) there was measured outcome data on all participants; and 3) all randomised participants were included in the analysis ( Higgins 2011b). We made judgements on attrition bias from these three criteria.

For reporting bias, we attempted to source prospective registration reports through information presented in study reports or from sifting of clinical trial register searches. We intended to judge bias by comparing prospective registration reports or protocols with outcomes reported in the full report.

Measures of treatment effect

We collected binary data for our outcomes related to death and analysed these using the Peto odds ratio (OR) and 95% confidence interval (CI). We collected continuous data reported as means (with standard deviations) for outcomes relating to activities of daily living, extended activities of daily living, health‐related quality of life (participant and carers), mood and distress scores (participant and carers). We calculated the standardised mean difference from continuous data using inverse variance, to account for differences in the assessment tools used to measure the same outcome.

Unit of analysis issues

In the event we had included a trial using a cluster design (in which participants were randomised at group level) we would have used the intra‐cluster correlation coefficient (ICC) to estimate the effective sample size ( Higgins 2011c).

Dealing with missing data

The primary aim of this review was to obtain standardised data through collaboration with the original investigators. Incomplete data are relatively common in trials of rehabilitation. It is difficult to impute missing values for continuous outcomes. Where data were missing from a published report, we contacted the primary investigators in an attempt to get this information.

Assessment of heterogeneity

We assessed whether there was evidence of inconsistency in our results by considering possible methodological, clinical, and statistical heterogeneity. We assessed clinical and methodological heterogeneity by comparing similarities in our included studies between study designs, participants, interventions, and outcomes.

We assessed statistical heterogeneity by visually examining forest plots, and by performing the Chi ² test using a P value of less than 0.1 to indicate statistically significant heterogeneity. We used a P value of less than 0.1 rather than the conventional cut‐off point of 0.05 because of the low power of this test. We quantified the effect of heterogeneity using the I ² statistic including its 95% CI. We used the following cut‐offs as a guide to interpretation: I ² at 0% to 40% was not considered important, 30% to 60% suggested moderate heterogeneity, 50% to 90% suggested substantial heterogeneity, and 75% to 100% was considerable heterogeneity ( Higgins 2011c).

Assessment of reporting biases

We searched clinical trials registers to identify published protocols for each of our included studies. We intended to compare published protocols with published study results to assess the risk of selective reporting bias. If we had identified sufficient included studies (i.e. more than 10 studies ( Higgins 2011a)), we would have generated a funnel plot to assess risk of publication bias in the review; an asymmetrical funnel plot may suggest publication of only positive results ( Egger 1997).

We employed a comprehensive search strategy in an effort to avoid reporting biases in our review methodology. See Search methods for identification of studies.

Data synthesis

We completed meta‐analysis of outcomes for which we had comparable effect measures from more than one study, and when measures of heterogeneity indicated that pooling of results was appropriate. We used the statistical calculator provided in RevMan ( RevMan 5.3) to perform meta‐analysis.

We used a fixed‐effect model ( Mantel 1959). We assessed the robustness of the results to choice of model using sensitivity analysis.

We limited the primary analysis to studies with an overall low or unclear risk of bias. We reached decisions on overall risk of bias per study by consideration of four risk of bias domains: sequence generation, allocation concealment, outcome assessment, and incomplete outcome data. We required a study to have a judgment of low risk of bias in all four domains in order to categorise it as having an overall low risk of bias. We categorised a study that had both low and unclear judgements to have an overall unclear risk of bias. We did not include studies with high risk of bias judgements in these four domains in any of our primary analyses; we reconsidered this decision in sensitivity analysis.

Subgroup analysis and investigation of heterogeneity

If there had been sufficient studies, we would have explored variability in the participants, interventions, and outcomes among studies using the following subgroups:

1. hospital‐based occupational therapy interventions versus community‐based occupational therapy interventions within three months of stroke onset;

2. single versus multiple staff providing the experimental intervention ( Higgins 2011a); and

3. randomisation to treatment within one year of stroke onset versus randomisation to treatment more than one year after stroke onset.

Sensitivity analysis

We explored the potential effects of decisions made as part of the review process as follows.

1. We included all studies regardless of risk of bias judgement.

2. We conducted meta‐analysis using the alternate meta‐analytical effects model (fixed‐effect or random‐effects).

3. We conducted a sensitivity to missing data analysis by first adding missing participants to the denominator in the intervention and control groups (missing participants better) and second, adding missing participants to the denominator and the numerator in the intervention and control groups (missing participants worse).

We compared effect estimates from the above results with effect estimates from the main analysis. We aimed to report differences that altered interpretation of effects.

We performed sensitivity analyses, where appropriate, on the following outcomes:

1. performance in activities of daily living;

2. odds of poor outcome (death and deterioration or death and dependency).

GRADE and 'Summary of findings'

We assessed the overall quality of the evidence for our outcome using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation Working Group) approach, as recommended in the Cochrane Handbook for Systematic Reviews of Interventions ( Higgins 2011d). The quality of the evidence for a specific outcome is based on the performance of the studies against five criteria: study design and limitations, directness of evidence, consistency of results, precision (sufficient data), and reporting of results across all studies that measure a specific outcome. This approach yields an overall measure of how confident we can be that our estimate of effect is correct ( Guyatt 2008). We used the principles of the GRADE system to prepare an overall assessment of evidence related to each of the following outcomes.

1. Performance in activities of daily living.

2. Death or 'poor outcome' (deterioration or dependency).

3. Extended activities of daily living.

4. Mood or distress

We (LL and SL) independently used GRADEpro software (http://www.guidelinedevelopment.org/) to create a 'Summary of findings' table for each comparison. We reached consensus and resolved disagreements by consulting a third review author, if required.

Study design and limitations refers to the results of the 'risk of bias' assessment ( Assessment of risk of bias in included studies). Directness of evidence refers to the comparability of population, interventions, and outcomes of interest in the included studies. We described any concerns regarding comparability of the included studies. Consistency of results refers to similarity in treatment effect in results across the included studies and includes the direction and size of effect and statistical significance. We considered overlap of confidence intervals to indicate statistical homogeneity. We also used the Chi ² test of significance for heterogeneity using a P value of less than 0.10 to indicate statistical significance and used I ² as an index of heterogeneity. Precision refers to the effect of study size on the precision of the estimate of treatment effect. For each outcome, we noted the sample size and magnitude and direction of the experimental intervention's effect compared with the control intervention ‐ specifically the width of the confidence interval surrounding the estimate i.e. whether the width was narrow indicating more precision) or wider (indicating more uncertainty) ( Higgins 2011d). Publication bias refers to the likelihood of selective publication of studies or outcomes. Had there been a sufficient number of studies we would have assessed probability of selective outcome reporting as part of the assessment of risk of bias using funnel plots as visual tools for examining publication and other bias (i.e. small study effects).

Description of studies

See: Characteristics of included studies; Characteristics of excluded studies; Characteristics of studies awaiting classification; Characteristics of ongoing studies

Results of the search

For this update, we screened 38,671 references from database searches and accessed the available full‐text reports for 32 studies. We screened 191 studies in the Cochrane Stroke Group Trials Register and accessed the available full‐text reports for three studies. We screened 1069 reports from clinical trial registers and 116 reports available from grey literature searching.

We considered nine studies identified as eligible in the previous version of this review and considered two studies that were awaiting classification in the previous version ( Legg 2006).

The flow of search results for the previous version of the review are reported in Legg 2006. We reported details of the search for this update in a PRISMA flow chart. See Figure 1 .

Risk of bias in included studies

See Figure 2 and Figure 3

Blinding

It is not feasible to prevent study personnel, participants, or caregivers from knowing that an occupational therapy intervention was received; we judged all studies to have high risk of performance bias.

For all other outcomes, we considered the type of assessment tool, who carried out the assessment and how, and whether, the assessor was blinded to participant allocation.

One study used an outcome measure (FIM) designed to be administered by a trained and certified assessor; however, the study authors did not report if the observers were blinded and therefore we judged this study to have unclear risk of bias ( Chui 2004). Five studies did not report how the outcome evaluation data were collected (i.e. by objective observation or obtained directly from participants through interview or self‐completed questionnaire); these studies did not provide us with sufficient information to judge risk of bias ( Drummond 1996; Gilbertson 2000; Logan 1997; Walker 1996; Walker 1999).

Two studies reported that performance in ADL outcome data were collected directly from participants through self‐completed postal questionnaires ( Corr 1995; Parker 2001). One study reported that approximately 34% of participant‐reported outcomes were completed by carers ( Parker 2001). One study used a blinded outcome assessor to collect FIM data directly from the participant through telephone interview ( Radomski 2007). As knowledge of the assigned intervention may impact on participant‐reported outcomes, we judged these to have unclear risk of bias.

Selective reporting

None of the included studies provided details of prospective registration with clinical trial registers or references for prospectively written study protocols; it was not feasible to judge risk of reporting bias for all studies.

Other potential sources of bias

We noted some gender imbalances between groups in one study ( Corr 1995). We did not know if this had the potential to influence study results; we judged this study to have unclear risk of bias. We identified no other sources of bias in the remaining studies.

Overall risk of bias

None of the studies had an overall low risk of bias (i.e. no studies had low risk of bias in each of four domains: sequence generation, allocation concealment, outcome assessment, incomplete outcome data). One study had an overall high risk of bias, with high risk of bias in one of these four domains ( Radomski 2007). Remaining studies had an overall unclear risk of bias (i.e. with assessments of both low and unclear risk in each of the four domains).

Effects of interventions

See: Table 1

Summary of findings for the main comparison

Primary outcomes

Personal activities of daily living

Eight of the nine included studies reported a measure of personal ADL; data from Radomski 2007 was not included because it had an overall high risk of bias. We combined data for studies with an overall unclear risk of bias for the outcome of personal activities for daily living using a standardised mean difference (SMD) with a fixed‐effect model (SMD 0.17 (95% CI 0.03 to 0.31); P = 0.02; 7 studies; 749 participants; low‐quality evidence) with no significant heterogeneity (Chi² = 4.74, df = 6 (P = 0.58); I² = 0%). Therefore, participants who received an occupational therapy intervention after stroke were more independent in personal activities of daily living than those participants who received no intervention or standard care/practice. See Table 2 for information about completeness of data. See Analysis 1.1 and Table 1 .

Death or a poor outcome

We combined data for studies with an overall unclear risk of bias for the combined odds of death or a poor outcome (dead and deteriorated or dead and dependent) using the Peto odds ratio (OR 0.71, (95% CI 0.52 to 0.96); P = 0.03; 5 studies; 771 participants; low‐quality evidence) with no statistically significant heterogeneity between studies (Chi² = 3.12, df = 4 (P = 0.54); I² = 0%). Therefore, participants who received an occupational therapy intervention after stroke were less likely to experience a poor outcome compared to those participants who received no intervention or standard care/practice ( Analysis 1.2 ; Table 1 ). For information about completeness of data see Table 3 .

Secondary outcomes

Extended activities of daily living

We excluded Radomski 2007 because it had an overall high risk of bias. We combined data for studies with an overall unclear risk of bias for the outcome of extended activities for daily living using SMD with a fixed‐effect model (SMD 0.22 (95% CI 0.07 to 0.37); P = 0.005; 5 studies; 665 participants; low‐quality evidence) with no significant heterogeneity (Chi² = 4.96, df = 4 (P = 0.29); I² = 19%). Therefore, participants who received an occupational therapy intervention after stroke were more independent in extended activities of daily living than those participants who received no intervention or standard care/practice ( Analysis 1.6 ). For information about completeness of data see Table 7 .

Health‐related quality of life

One study (108 participants) reported outcome data for health‐related quality of life ( Gilbertson 2000). The study authors reported no difference in health‐related quality of life for participants who received occupational therapy compared with those who received standard care/practice. For information about completeness of data see Table 8 .

Unpaid carers: mood or distress

We found no studies that explicitly reported inclusion of consenting and recruiting unpaid carers that collected data on mood or distress.

Unpaid carers: health‐related quality of life

We found no studies that explicitly reported inclusion of consenting and recruiting unpaid carers that collected data on health‐related quality of life.

Satisfaction with services

One study collected information on participant and carer satisfaction with services ( Gilbertson 2000). The measurement tool was not validated and data were unclearly reported. We did not contact the author for clarification.

Subgroup analysis by intervention characteristic

We did not perform subgroup analyses according to intervention characteristics.

1. We found no studies comparing hospital‐based occupational therapy interventions with community‐based occupational therapy interventions. All studies were community based.

2. Only one study tested multiple staff providing the occupational therapy intervention ( Parker 2001); the remaining studies tested single occupational therapist interventions.

3. All eligible studies randomised participants to treatment within one year of stroke onset.

Sensitivity analyses

Inclusion of all studies regardless of risk of bias judgement

For outcome performance in activities of daily living, when we included all studies regardless of risk of bias judgement there was no change to interpretation of the result, with improved independence in activities of daily living for participants who had received an occupational therapy intervention (SMD 0.16 (95% CI 0.02 to 0.30; P = 0.03; 8 studies; 759 participants; fixed‐effect model).

We judged all studies included in our second primary outcome (death or 'poor outcome') to have an overall unclear risk of bias; there were no alternative data to analyse in sensitivity analysis for this outcome.

Meta‐analysis using the alternate meta‐analytical effects model (fixed‐effect or random‐effects).

Reanalysis of the data for our primary outcomes (personal activities of daily living, and death or poor outcome) using the random‐effects analysis model did not alter the result.

Sensitivity to missing data.

If we assumed that the participants who were missing from the intervention groups (40/425 (9.4%)) and control groups (47/432 (10.9%) were alive and well and living at home, then the odds of a poor outcome was still reduced for those participants receiving occupational therapy interventions (OR 0.75 (95% CI 0.56 to 1.00); P = 0.05) with no statistically significant heterogeneity (Chi² = 3.36, df = 4 (P = 0.50); I² = 0%). Alternatively, when we considered participants who were missing from the intervention groups and control groups to be either dead or having a poor outcome (deterioration or dependency), then the odds of a poor outcome was still reduced for those participants receiving occupational therapy interventions (OR 0.75 (95% CI 0.56 to 0.99); P = 0.04) with no statistically significant heterogeneity (Chi² = 3.06, df = 4 (P = 0.55); I² = 0%) ( Analysis 1.8 ; Analysis 1.9 ).

Summary of main results

For this update, we included nine studies with 994 participants.

We found that occupational therapy delivered to adults after stroke and targeted towards activities of daily living increased ADL scores and reduced the risk of poor outcome (the combined odds of death and deterioration or dependency in activities of daily living). We also found that those who received occupational therapy were more independent in extended activities of daily living. Occupational therapy did not influence mortality or reduce the combined odds of death and dependency, death and deterioration or death and institutionalisation; however, data were incomplete and only available for a few studies. Occupational therapy did not improve mood or distress scores. There were insufficient data to determine the effects of occupational therapy on health‐related quality of life. We found no studies of consenting unpaid 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.

We used GRADEpro to assess the quality of our evidence for the outcomes: personal activities of daily living, death or a poor outcome, or extended activities of daily living. We judged the evidence to be low‐quality.

Overall completeness and applicability of evidence

We conducted a thorough search, including searches of grey literature and clinical trial registers. Included studies all compared an occupational therapy intervention with no intervention or standard care/practice, and included participants who were adults with stroke. We excluded studies that used occupational therapy as part of multidisciplinary approach, although therapy may typically be received as part of a multidisciplinary process. Studies were published from 1995 to 2017, with seven studies based in the UK, one in the US, and one in Hong Kong. All studies were directly applicable to our review objective.

Whilst the studies were all appropriate, we identified few trials with few participants and we considered that such limited data led to imprecision in the effect estimates for our primary outcomes and the effect on extended activities of daily living. We used GRADEpro to downgrade the quality of our evidence due to this imprecision.

Quality of the evidence

We used the 'Risk of bias' tool to assess study methodology. Reporting methods used by study authors were often incomplete. Only three of the nine studies described both a suitable method of randomisation and method of allocation concealment. There was inevitable high risk of performance bias in all studies as personnel and participants could not be blinded to their group allocation. We did not consider that lack of blinding of outcome assessors for outcomes relating to death would influence assessment. However, we gave careful consideration to the assessment of all other outcomes: we considered the variety of assessment tools, including observation, participant self‐assessment, completion of questionnaires and telephone interviews, used by outcome assessors. Whilst some study authors reported that outcomes assessors were independent, we were not able to judge whether any of the studies were at a low or high risk of detection bias because of the methods used to assess outcomes and the lack of blinding of participants. Although some study authors reported loss of participants, this was balanced between groups and we judged most studies to have a low risk of attrition bias. No included studies provided details of prospective trial registration and we could not judge risk of selective outcome reporting bias.

We used GRADEpro to downgrade the quality of our evidence due to study limitations.

Potential biases in the review process

We conducted the review using robust Cochrane methodology, with two review authors independently assessing studies for eligibility, extracting data, and carrying out 'risk of bias' assessment.

We made some changes to the review during this update. We altered the inclusion criteria so that studies that were carried out in nursing homes were no longer eligible; this removed one previously included study which is included in another Cochrane review. We reviewed the decision to include data from carers who had not consented to participate; we did not conduct any analysis on any carer‐related outcomes. We reviewed the decision to combine data in multi‐arm studies; we only used data from the intervention arm that was closest to the review objectives but we no longer had available data for one study. We reviewed the decision to include all studies in meta‐analysis; we only included studies that had an overall low or unclear risk of bias.

We made these changes to the review in order to increase the robustness of our evidence. We assessed the decision regarding inclusion of only studies with low or unclear risk of bias in sensitivity analysis and results were not changed. Comparing the effect estimates in the 2017 update with those in the original review do not suggest that our decisions have introduced bias.

Agreements and disagreements with other studies or reviews

We found one systematic review, Reinsperger 2012, published in German, that had reported the methods and results of the original occupational therapy review ( Legg 2006) and provided an update of the original review. The review authors searched for and included new studies. The studies identified by Reinsperger 2012 did not meet our review inclusion criteria. Further, the authors failed to identify many of the studies that were potential studies for inclusion. The authors concluded that occupational therapy led to an improvement in outcomes for adults after stroke; this review did not include an assessment of quality of the evidence using GRADE.

Occupational therapy does appear to improve performance in activities of daily living and reduce the odds of deterioration in those abilities. We assessed the quality of the evidence as low and as such our confidence in the effect estimates is limited and the true effect may be substantially different from our estimates. Further evidence as to the clinical and cost effectiveness of occupational therapy interventions after stroke is required as, due to the quality of evidence, the current data support the provision of occupational therapy but the confidence in this is limited and could be overturned by further trials.

The majority of studies included in this review test the effects of a single occupational therapist working with adults with stroke to improve ADL; these trial therapists may or may not be representative of the broader occupational therapy workforce. Good quality, large, multiple therapist, no intervention or standard care/practice comparator randomised controlled studies are required to establish the clinical and cost effectiveness of occupational therapy after stroke. Occupational therapists operate in hospital‐based specialist stroke services, in non‐specialist setting serving stroke patients and in community settings and therefore studies should be conducted across a range of sites with the results stratified and interpreted by site. Studies, with clearly reported methods, should be focused on areas where occupational therapy may deliver significant clinical benefits through improved performance in ADL, or cost effectiveness benefits through faster rehabilitation and discharge.

Date

Event

Description

31 March 2017

New citation required and conclusions have changed

Occupational therapy increases independence in activities of daily living and reduces the odds of a poor outcome (deterioration or dependency). However, the evidence was rated low‐quality. This is a change to the conclusions of the original review. The changes to the conclusions are a result of incorporating 'risk of bias' assessments.

2 January 2017

New search has been performed

We changed the Background section, to add further explanation of how the intervention might work.
We included one new trial with 10 participants. We need further information on five trials to assess eligibility. Two trials are ongoing. The review now has 9 included studies, involving 994 participants. We excluded any trials that tested interventions delivered to people with stroke living in long‐term care. Therefore, we excluded one previously included study ( Sackley 2004).
We improved the search strategies and history. We did not handsearch journals. We extended our search of trial registers.
Previously, we had included each intervention arm as a combined dataset compared to the control group. In this 2017 update, we selected the intervention that most closely related to our intended intervention. Therefore, we excluded data from leisure promotion intervention arms from two studies: Drummond 1996 and Parker 2001.
We incorporated Cochrane's tool for assessing risk of bias into this update. We revisited the critical appraisal of all studies included in previous versions of both reviews updating all assessments of risk of bias.
We incorporated 'risk of bias' assessments in analyses by restricting the primary analysis to studies at low and unclear risk of bias.
We adhered to the MECIR standards for conduct and reporting.

Date

Event

Description

3 September 2008

Amended

Converted to new review format.

We thank Dr Mary V Radomski for providing us with a copy of her PhD thesis.

We thank Alex Pollock (Lead editor); Jan Mehrholz (Second editor); Hazel Fraser (Managing editor); Joshua Cheyne (Information specialist): Valentina Assi (Statistician); Stefania Fugazzaro (External referee); and Danny Minkow (Consumer referee) for help and editorial advice provided during preparation of this systematic review.

Appendix 8. OpenGrey search strategy

stroke AND (occupational therapy OR rehabilitation)

Appendix 9. US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and World Health Organization International Clinical Trials Registry Platform search strategies

stroke AND (occupational therapy OR rehabilitation)

Comparison 1

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Characteristics of studies awaiting assessment [ordered by study ID]

Characteristics of ongoing studies [ordered by study ID]

Differences between original review (Legg 2006) and 2017 update

Changes to 'Background'

We edited the Background section; we added more detail with the purpose of clarifying, justifying, and updating the review.

Changes to 'Search methods for identification of studies'

We did not search the following databases during the 2017 update because of lack of access to databases:

Dissertations and Theses Database, 1861‐ ProQuest;

World Health Organization Library Information System (WHOLIS/IRIS), Virtual Health Library (VHL).

We searched PsycINFO, not PsycLIT, which has been discontinued by the American Psychological Association.

We did not complete the following searches during the 2017 update:

Changes to 'Criteria for considering studies for this review'

We edited the Types of interventions section: we added additional detail to clarify existing inclusion criteria. We altered the review criteria so that interventions conducted in a nursing home environment were excluded. These are considered elsewhere ( Fletcher‐Smith 2013). We also stated that we would exclude trials of occupational therapy interventions in combination with other interventions, and trials that tested specific treatment approaches; this additional detail was to clarify existing exclusion criteria that had not been reported in the methods of the original review.

Changes to 'Data collection and analysis'

Previously we had included each intervention arm as a combined data set compared with the control group. In the 2017 update, we selected the intervention that most closely related to our intended intervention. This decision affected analysis of data for Drummond 1996 and Parker 2001, in which we excluded data from an intervention arm of promotion of leisure skills in each study.

In this 2017 update, we did not include carer‐related outcome data if there was no description of carer consent to study participation in the full study report.

Changes to Results

We excluded Sackley 2004 (previously named Nottingham 2001) from the 2017 update. This study was no longer eligible because of changes to the criteria for considering studies for this review.

External sources

Chest Heart and Stroke, Scotland, UK.

The Big Lottery Fund, UK.

National Institute for Health Research, UK.

Incentive funding

Corr 1995 {published and unpublished data}

Logan 1997 {published and unpublished data}

Logan P, Ahern J, Gladman JRF, Lincoln NB. A randomized controlled trial of enhanced Social Service occupational therapy for stroke patients. Clinical Rehabilitation 1996;10:107‐13. [[PubMed] Google Scholar]

Parker 2001 {published and unpublished data}

Parker CJ, Gladman JRF, Drummond AER, Dewey ME, Lincoln NB, Barer D, et al. A multicentre randomized controlled trial of leisure therapy and conventional occupational therapy after stroke. Clinical Rehabilitation 2001;15:42‐52. [[PubMed] Google Scholar]

Walker 1996 {published and unpublished data}

Walker 1999 {published and unpublished data}

Walker MF, Gladman JRF, Lincoln NB, Siemonsa P, Whitely T. Occupational therapy for stroke patients not admitted to hospital. Lancet 1999;354:278‐80. [[PubMed] Google Scholar]

Andrea 2003 {published data only}

Chaiyawat 2012 {published data only}

Desrosiers 2007 {published data only}

Guidetti 2011 {published data only}

Kessler 2014 {published data only}

Rasmussen 2016 {published data only}

Rodgers 2015 {published data only}

Rodgers H, Shaw L, Cant R, Drummond A, Ford GA, Forster A, et al. Evaluating an extended rehabilitation service for stroke patients (EXTRAS): study protocol for a randomised controlled trial. Trials 2015;16:205. [PUBMED: 25939584] [[PubMed] PMC free article] [Google Scholar]

Sackley 2004 {published and unpublished data}

Skidmore 2012 {published data only}

Walker 2012 {published data only}

Whitehead 2016 {published data only}

Whitehead PJ, Walker MF, Parry RH, Latif Z, McGeorge ID, Drummond AER. Occupational Therapy in HomEcare Re‐ablement Services (OTHERS): results of a feasibility randomised controlled trial. BMJ Open 2016; Vol. 6, issue 8:e011868. [PUBMED: 27531732] [PubMed]PMC free article] [

Yu 2009 {published data only}

References to ongoing studies

Additional references

Covidence [Computer program]

Veritas Health Innovation Ltd. Covidence. Melbourne: Veritas Health Innovation Ltd, (accessed 23 October 2015).

Endnote [Computer program]

Thomson Reuters. Endnote X5. New York: Thomson Reuters, 2011.

Fletcher‐Smith 2013

Fletcher‐Smith JC, Walker MF, Cobley CS, Steultjens EMJ, Sackley CM. Occupational therapy for care home residents with stroke. Cochrane Database of Systematic Reviews 2013, Issue 6. [DOI: 10.1002/14651858.CD010116.pub2] [[PubMed] [CrossRef] PMC free article] [Google Scholar]

RevMan 5.3 [Computer program]

Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

Legg 2006

Legg L, Drummond A, Langhorne P. Occupational therapy for patients with problems in activities of daily living after stroke. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD003585.pub2] [[PubMed] [CrossRef] PMC free article] [Google Scholar]

# data[].attributes.attachment_link.title
Occupational therapy for adults with problems in activities of daily living after stroke

# data[].attributes.attachment_link.description
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 ...

# data[].attributes.headline
Occupational Therapy Interventions for Client's Who Present with Burn Injuries  

# data[].attributes.subject
Occupational Therapy Interventions for Client's Who Present with Burn Injuries  

# data[].attributes.body
McGourty, L. K., Givens, A., & Fader, P. B. (1985). Roles and functions of occupational therapy in burn care delivery. The American Journal of Occupational Therapy, 39(12), 791–794. https://doi.org/10.5014/ajot.39.12.791

# data[].attributes.headline
Activities of daily living in people with lower limb amputation: outcomes of an intervention to reduce dependence in pre-prosthetic phase

# data[].attributes.subject
Activities of daily living in people with lower limb amputation: outcomes of an intervention to reduce dependence in pre-prosthetic phase

# data[].attributes.body
De-Rosende Celeiro, I., Sanjuán, L. S., & Santos-Del-Riego, S. (2017). Activities of daily living in people with lower limb amputation: outcomes of an intervention to reduce dependence in pre-prosthetic phase. Disability and Rehabilitation, 39(18), 1799–1806. https://doi.org/10.1080/09638288.2016.1211757

# data[].attributes.attachment_link.readable_text
Affiliations

¹ a Departamento de Ciencias da Saúde , Universidade da Coruña , A Coruña , Spain.

² b Servicio de Rehabilitación , Complexo Hospitalario Universitario A Coruña , A Coruña , Spain.

³ c Departmento de Medicina , Universidade da Coruña , A Coruña , Spain.

Affiliations

¹ a Departamento de Ciencias da Saúde , Universidade da Coruña , A Coruña , Spain.

² b Servicio de Rehabilitación , Complexo Hospitalario Universitario A Coruña , A Coruña , Spain.

³ c Departmento de Medicina , Universidade da Coruña , A Coruña , Spain.

Abstract

Purpose: The main objective was to assess the change in the functional independence in basic activities of daily living (ADL) following a pre-prosthetic intervention in people with lower-limb amputation (LLA). Secondary objectives were to identify the factors contributing to the success of this intervention, and to analyze the effects on the presence of unmet needs for home adaptation.

Method: The ADL intervention was early and pre-prosthetic; it was focused on six self-care activities. Fifty-two adults with LLA, who required assistance in self-care, were included. Functional independence (Barthel) was assessed at baseline and after intervention (T2). Successful intervention was defined as independent performance of all self-care activities.

Results: There was a significant improvement in Barthel scores between baseline and T2 in toileting (p < 0.001), bed-chair transfers (p < 0.001), dressing (p < 0.001), bathing/showering (p < 0.001), and feeding (p = 0.025). The proportion of homes with an unmet need for adaptation decreased significantly in bathroom (p = 0.008) and other internal areas (p = 0.031). Intervention was successful for 61.5% of participants. In a multivariate model, age was significantly associated with successful intervention (OR 0.66, 95%CI 0.52-0.83).

Conclusions: A short and pre-prosthetic ADL intervention improves functional independence and reduces the need for home adaptation. ADL programs should be included in rehabilitation strategies. Implications for Rehabilitation Because basic activities of daily living (ADL) can be seriously compromised after a lower-limb amputation, it is important for this population to improve or maintain their level of independence. A short and pre-prosthetic ADL intervention is an effective method for an early recovery of functional independence in self-care activities and promotes home adaptation. Age is an important determinant of functional recovery, and most subjects can achieve independence in basic ADL regardless of the level of amputation. A pre-prosthetic ADL program should be included in rehabilitation strategies for adults with lower-limb amputation.

Keywords: Activities of daily living; amputation; lower limb; occupational therapy; outcomes.

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