Stroke Structured Abstract - S #1
More research is needed on whether occupational therapy treatment for stroke patients after hospital discharge improves activities of daily living
CITATION: Corr, S., & Bayer, A. (1995). Occupational Therapy for stroke patients after hospital discharge: A randomized controlled trial. Clinical Rehabilitation, 9, 291-296.
LEVEL OF EVIDENCE: IA2a
What is the effectiveness of occupational therapy interventions on stroke patients after their discharge from a stroke unit?
Randomized controlled trial (RCT)
Subjects were randomly assigned to either an OT intervention group or to a no-treatment control group.
SAMPLING PROCEDURE/INCLUSION CRITERIA
Consecutive patients discharged between April 1991 and January 1992 from the two stroke units in South Glamorgan were included in the study, irrespective of discharge destination.
N = 110 (89 finished)
Male = 41
Female = 69
Mean age = 75.5
LCVA = NR
RCVA = NR
Attrition ≈ 19%
Chronic (1 year post)
NR = Not Reported
(R = Reliability established; V = Validity established)
Barthel Index - R, V
Nottingham Extended ADL Scale - R
Geriatric Depression Scale - R
Pearl's Six Point Quality of Life Scale - R
Use of services
Experimental group: Occupational therapy intervention was based on the Model of Human Occupation. The interventions included teaching new skills, facilitating more independence in activities of daily living (ADL), facilitating return of function, enabling patients to use equipment supplied by other agencies, giving information to the patients and caregivers, and referring to or liaisoning with other agencies.
Control Group: No special intervention or follow-up services.
WHO DELIVERED INTERVENTION
OT - individual treatment
FREQUENCY & DURATION
Intervention was provided four times: at 2, 8, 16, and 24 weeks following discharge.
Duration of entire treatment program was 24 weeks.
There were significant differences between the two groups (on a postal questionnaire) at 1 year after discharge on some items of the Nottingham Extended ADL Scale: Feeding (p = .04, r = .22) and telephone use (p = .002, r = .32), but no significant difference on the total Nottingham Extended ADL Scale score.
Pearlman's Six Point Quality of Life Scale(QOL): Not Significant, r = .02
Barthel Index (ADL): Not Significant, r = .03
Geriatric Depression Scale: X 2 = 1.79, p < .25,φ = .15, r = -18*
Home circumstances: r = .13
The intervention group received significantly more aids (toilet & stair rails): p = .05, r = .20
The intervention group had significantly fewer admissions to hospital (p = .003, r = .23).
Within Groups/Conditions/Times: Not Tested
* A negative effect size indicates that the outcome was opposite of the expectation or hypothesis.
THREATS TO VALIDITY
Large number of outcomes tested.
Attrition rate was 19%.
Lacks placebo control group to control for attention.
Independent variable - OT treatment - too weakly applied (only four treatments over a 6-month period).
Outcome was measured by postal questionnaire 6 months after the last treatment. This could dilute the effect because of elapsed time without therapy and reliance on the memory of elderly people.
Providing follow-up service by an occupational therapist benefits stroke patients by addressing any problems they have postdischarge, ensuring that they receive all necessary aids, and helping to maintain them at home.
Providing infrequent OT interventions for stroke patients after hospital discharge seems not to be very effective in enhancing patients' ADL, depression status, or QOL. This study only provided OT services four times during the first 6 months after discharge; the intensity of treatment might not be enough. Further research with higher treatment intensity is needed.
The outcome was measured 6 months after the last treatment, possibly further diluting the effects.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Hui-ing Ma, ScD, OTR, and Catherine A. Trombly, ScD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.