on February 27, 2003
Published online before print February 27, 2003, doi: 10.1161/01.STR.0000057576.77308.30
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on September 9, 2002
From the Netherlands Institute for Health Care Research, Utrecht (E.M.J.S., C.H.M. van den E.); Department of Rehabilitation Medicine (J.D.) and Institute for Research in Extramural Medicine (L.M.B.), VU University Medical Center, Amsterdam; University of Professional Education, Amsterdam (J.C.M. van de N.), and Department of Occupational Therapy, University Medical Center Nijmegen, Nijmegen (E.H.C.C.), the Netherlands. * To whom correspondence should be addressed. E-mail: e.steultjens{at}nivel.nl.
Background and Purpose--Occupational therapy (OT) is an important aspect of stroke rehabilitation. The objective of this study was to determine from the available literature whether OT interventions improve outcome for stroke patients. Methods--An extensive search in MEDLINE, CINAHL, EMBASE, AMED, and SCISEARCH was performed. Studies with controlled and uncontrolled designs were included. Seven intervention categories were distinguished and separately analyzed. If a quantitative approach (meta-analysis) of data analysis was not appropriate, a qualitative approach (best-evidence synthesis), based on the type of design, methodological quality, and significant findings of outcome and/or process measures, was performed. Results--Thirty-two studies were included in this review, of which 18 were randomized controlled trials. Ten randomized controlled trials had a high methodological quality. For the comprehensive OT intervention, the pooled standardized mean difference for primary activities of daily living (ADL) (0.46; CI, 0.04 to 0.88), extended ADL (0.32; CI, 0.00 to 0.64), and social participation (0.33; CI, 0.03 to 0.62) favored treatment. For the training of skills intervention, some evidence for improvement in primary ADL was found. Insufficient evidence was found to indicate that the provision of splints is effective in decreasing muscle tone. Conclusions--This review identified small but significant effect sizes for the efficacy of comprehensive OT on primary ADL, extended ADL, and social participation. These results correspond to the outcome of a systematic review of intensified rehabilitation for stroke patients. The amount of evidence with respect to specific interventions, however, is limited. More research is needed to enable evidence-based OT for stroke patients.
Accepted on September 18, 2002
Occupational Therapy for Stroke Patients. A Systematic Review
Esther M.J. Steultjens MA*;
Key words: meta-analysis • occupational therapy • stroke
This article has been cited by other articles:
 |
|
 |
|
  Cumberland Consensus Working Group, B. Cheeran, L. Cohen, B. Dobkin, G. Ford, R. Greenwood, D. Howard, M. Husain, M. Macleod, R. Nudo, et al. The Future of Restorative Neurosciences in Stroke: Driving the Translational Research Pipeline From Basic Science to Rehabilitation of People After Stroke Neurorehabil Neural Repair, February 1, 2009; 23(2): 97 - 107. [Abstract] [PDF]
|
|
|
|
 |
|
 G. Saposnik, J. Fang, M. O'Donnell, V. Hachinski, M. K. Kapral, M. D. Hill, and on behalf of the Investigators of the Registry of Escalating Levels of Access to In-Hospital Care and Stroke Mortality Stroke, September 1, 2008; 39(9): 2522 - 2530. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Legg, A. Drummond, J. Leonardi-Bee, J R F Gladman, S. Corr, M. Donkervoort, J. Edmans, L. Gilbertson, L. Jongbloed, P. Logan, et al. Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials BMJ, November 3, 2007; 335(7626): 922 - 922. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. A. Lannin, A. Cusick, A. McCluskey, and R. D. Herbert Effects of Splinting on Wrist Contracture After Stroke: A Randomized Controlled Trial Stroke, January 1, 2007; 38(1): 111 - 116. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. De Wit, K. Putman, N. Lincoln, I. Baert, P. Berman, H. Beyens, K. Bogaerts, N. Brinkmann, L. Connell, E. Dejaeger, et al. Stroke Rehabilitation in Europe: What Do Physiotherapists and Occupational Therapists Actually Do? Stroke, June 1, 2006; 37(6): 1483 - 1489. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Song, C. Jerosch-Herold, R. Holland, M. d. L. Drachler, K. Mares, and I. Harvey Statistical methods for analysing Barthel scores in trials of poststroke interventions: a review and computer simulations Clinical Rehabilitation, April 1, 2006; 20(4): 347 - 356. [Abstract] [PDF]
|
|
|
|
|
|
I Lim, E van Wegen, C de Goede, M Deutekom, A Nieuwboer, A Willems, D Jones, L Rochester, and G Kwakkel Effects of external rhythmical cueing on gait in patients with Parkinson's disease: a systematic review Clinical Rehabilitation, July 1, 2005; 19(7): 695 - 713. [Abstract] [PDF]
|
|
|
|
 |
|
 B. H. Dobkin Rehabilitation after Stroke N. Engl. J. Med., April 21, 2005; 352(16): 1677 - 1684. [Full Text] [PDF]
|
|
|
|
|
|
E. M. Steultjens, J. Dekker, L. M Bouter, C. J Leemrijse, and C. H. van den Ende Evidence of the efficacy of occupational therapy in different conditions: an overview of systematic reviews Clinical Rehabilitation, March 1, 2005; 19(3): 247 - 254. [Abstract] [PDF]
|
|
|
|
 |
|
 C. A. Hanlon, A. L.H. Buffington, and M. J. McKeown New brain networks are active after right MCA stroke when moving the ipsilesional arm Neurology, January 11, 2005; 64(1): 114 - 120. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.F. Walker, J. Leonardi-Bee, P. Bath, P. Langhorne, M. Dewey, S. Corr, A. Drummond, L. Gilbertson, J.R.F. Gladman, L. Jongbloed, et al. Individual Patient Data Meta-Analysis of Randomized Controlled Trials of Community Occupational Therapy for Stroke Patients Stroke, September 1, 2004; 35(9): 2226 - 2232. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R P. Van Peppen, G Kwakkel, S Wood-Dauphinee, H J. Hendriks, P. J Van der Wees, and J Dekker The impact of physical therapy on functional outcomes after stroke: what's the evidence? Clinical Rehabilitation, August 1, 2004; 18(8): 833 - 862. [Abstract] [PDF]
|
|
|
|
 |
|
 ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB Evid. Based Med., January 1, 2004; 9(1): 3 - 3. [Full Text] [PDF]
|
|
|
|
|
|
Minerva BMJ, October 6, 2003; 327(7418): E225 - 225. [Full Text] [PDF]
|
|
|
|
 |
|
 OTHER ARTICLES NOTED (25 Apr 2003 to 18 Jul 2003) Evid. Based Nurs., October 1, 2003; 6(4): e1 - 12. [Full Text]
|
|
|
|
|
|
N A Lannin and R D Herbert Is hand splinting effective for adults following stroke? A systematic review and methodological critique of published research Clinical Rehabilitation, August 1, 2003; 17(8): 807 - 816. [Abstract] [PDF]
|
|
|
|
|
|
Minerva BMJ, March 22, 2003; 326(7390): 668 - 668. [Full Text] [PDF]
|
|