Nearly half of stroke survivors depend on others to carry out personal activities of daily living (ADL; e.g., feeding, bathing, dressing, and toileting). Rehabilitation therapies (e.g., physical therapy and occupational therapy) minimize dependency. However, the extent to which occupational therapy improves post-stroke outcomes is unclear. European investigators conducted a systematic review and meta-analysis of nine randomized trials involving 1258 patients to determine whether ADL-focused occupational therapy improves post-stroke outcomes.
Eight trials assessed ADL performance using validated measures; patients who received occupational therapy were significantly more independent in ADL performance than those who did not receive the intervention. Seven trials assessed the risk for “poor outcome,” a composite endpoint consisting of death or deterioration in ability to perform, or dependence on others to carry out, ADL. Occupational therapy significantly reduced the risk for “poor outcome.” Notably, eliminating trials with methodological flaws did not change the results of the analysis, and no evidence of publication bias was found.
Comment: Occupational therapy focused on activities of daily living improves post-stroke outcomes. The results of this study justify the common practice of prescribing occupational therapy for stroke patients. Future research should focus not on whether occupational therapy benefits stroke patients but rather, as the authors and an editorialist suggest, on determining which occupational therapy interventions uniquely benefit specific patients.
Paul S. Mueller, MD, MPH, FACP
Dr. Mueller is Associate Professor of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
Published in Journal Watch General Medicine December 4, 2007
Legg L et al. Occupational therapy for patients with problems in personal activities of daily living after stroke: Systematic review of randomised trials. BMJ 2007 Nov 3; 335:922.