Published Online
on July 22, 2004

A more recent version of this article appeared on September 1, 2004

This Article Full Text (PDF) All Versions of this Article: 35/9/2226    most recent 01.STR.0000137766.17092.fbv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Walker, M. F. Articles by Parker, C. Search for Related Content PubMed PubMed Citation Articles by Walker, M. F. Articles by Parker, C. Related Collections Exercise/exercise testing/rehabilitation

Submitted on December 10, 2003
Revised on March 25, 2004
Accepted on April 1, 2004

Individual Patient Data Meta-Analysis of Randomized Controlled Trials of Community Occupational Therapy for Stroke Patients

M. F. Walker PhD^*; J. Leonardi-Bee MSc; P. Bath MD; P. Langhorne PhD; M. Dewey PhD; S. Corr PhD; A. Drummond PhD; L. Gilbertson MPhil; J. R.F. Gladman DM; L. Jongbloed PhD; P. Logan MPhil; and C. Parker MSc

From the University of Nottingham (M.F.W., J.L.-B., P.B., A.D., J.R.F.G., P.Logan), United Kingdom; the University of Glasgow (P.Langhorne), United Kingdom; the University Kings College London (M.D.), United Kingdom; the University of Northampton (S.C.), United Kingdom; Pinderfields Hospital (L.G.), Leeds, United Kingdom; the University of British Columbia (L.J.), Canada; and the University of Sheffield (C.P.), United Kingdom.

^* To whom correspondence should be addressed. E-mail: marion.walker{at}nottingham.ac.uk.

Background and Purpose--Trials of occupational therapy for stroke patients living in the community have varied in their findings. It is unclear why these discrepancies have occurred.

Methods--Trials were identified from searches of the Cochrane Library and other sources. The primary outcome measure was the Nottingham Extended Activities of Daily Living (NEADL) score at the end of intervention. Secondary outcome measures included the Barthel Index or the Rivermead ADL (Personal ADL), General Health Questionnaire (GHQ), Nottingham Leisure Questionnaire (NLQ), and death. Data were analyzed using linear or logistic regression with a random effect for trial and adjustment for age, gender, baseline dependency, and method of follow-up. Subgroup analyses compared any occupational therapy intervention with control.

Results--We included 8 single-blind randomized controlled trials incorporating 1143 patients. Occupational therapy was associated with higher NEADL scores at the end of intervention (weighted mean difference [WMD], 1.30 points, 95% confidence intervals [CI], 0.47 to 2.13) and higher leisure scores at the end of intervention (WMD, 1.51 points; 95% CI, 0.24 to 2.79). Occupational therapy emphasizing activities of daily living (ADL) was associated with improved end of intervention NEADL (WMD, 1.61 points; 95% CI, 0.72 to 2.49) and personal activities of daily living (odds ratio [OR], 0.65; 95% CI, 0.46 to 0.91), but not NLQ. Leisure-based occupational therapy improved end of intervention NLQ (WMD, 1.96 points; 95% CI, 0.27 to 3.66) but not NEADL or PADL.

Conclusions--Community occupational therapy significantly improved personal and extended activities of daily living and leisure activity in patients with stroke. Better outcomes were found with targeted interventions.

Key words: community health services • occupational therapy • rehabilitation

This article has been cited by other articles:

				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]

				The Optimising Analysis of Stroke Trials (OAST) Co Can We Improve the Statistical Analysis of Stroke Trials?: Statistical Reanalysis of Functional Outcomes in Stroke Trials * OAST Supplemental Appendix I: Statistical Tests Compared (see Table I) * OAST Supplemental Appendix II: Supplementary Analyses * OAST Supplemental Appendix III: Trial Data (see Tables II and III) * OAST Supplemental Appendix IV: Results (see Table IV) Stroke, June 1, 2007; 38(6): 1911 - 1915. [Abstract] [Full Text] [PDF]

				J. Young and A. Forster Review of stroke rehabilitation BMJ, January 13, 2007; 334(7584): 86 - 90. [Full Text] [PDF]

				C. Sackley, D. T. Wade, D. Mant, J. C. Atkinson, P. Yudkin, K. Cardoso, S. Levin, V. B. Lee, and K. Reel Cluster Randomized Pilot Controlled Trial of an Occupational Therapy Intervention for Residents With Stroke in UK Care Homes Stroke, September 1, 2006; 37(9): 2336 - 2341. [Abstract] [Full Text] [PDF]