Stroke Structured Abstract - S #3
A leisure rehabilitation program may encourage stroke patients to participate in leisure activities and may improve their mobility and psychological well being
CITATIONS: Drummond, A. E. R, & Walker, M. F. (1995). A randomized controlled trial of leisure rehabilitation after stroke. Clinical Rehabilitation, 9, 283-290.
Drummond, A. E. R. & Walker, M. F. (1996). Generalisation of the effects of leisure rehabilitation for stroke patients. British Journal of Occupational Therapy, 59, 330-334.
LEVEL OF EVIDENCE: IB2a
Would introducing leisure programs into treatment encourage stroke patients to participate in leisure activities, and would the benefits generalize to activities of daily living?
Randomized controlled trial (RCT)
The subjects were randomly assigned to one of three groups: Leisure Rehabilitation Group, Conventional OT Group, or Control Group.
SAMPLING PROCEDURE/INCLUSION CRITERIA
All patients admitted to the Stroke Unit in Nottingham (United Kingdom), between October 1990 and July 1992 were considered for inclusion if they spoke English, had no severe comprehension problems, had no history of dementia, did not need to be transferred for further medical treatment, and had an address serviced by the Nottingham District Health Authority.
N = 65
Male = 37
Female = 28
Mean age = 66
LCVA = 23
RCVA = 41
Attrition ≈ 7%
The subjects in the Leisure Rehabilitation Group were significantly younger than the subjects in the other two groups. One patient was neither LCVA nor RCVA.
(R = Reliability established; V = Validity established)
Nottingham Leisure Questionnaire - R, V
Nottingham Extended ADL Scale - R
Nottingham Health Profile (psychological well-being) - R
Wakefield Depression Inventory - R
Experimental Group: Leisure Rehabilitation Group: Practice of transfers needed for leisure pursuits, positioning, provision of equipment, advice on obtaining financial assistance and transportation, liaison with specialist organizations, and provision of physical assistance, such as transportation to voluntary agencies.
Control Group #1: Conventional Occupational Therapy Group: OT activities such as transfers and dressing practice. No help or advice was offered to encourage participation in leisure pursuits.
Control Group #2: No treatment
WHO DELIVERED INTERVENTION
FREQUENCY & DURATION
Once per week for the first 12 weeks following discharge. Thereafter, every other week for the next 12 weeks.
30 minutes per visit.
Duration of the program was 6 months.
- Compared with Control Group #2, on the Nottingham Leisure Questionnaire: TOTL (total leisure score) was significantly greater (p < .001, r = .58) and TLA (total leisure activity score) was significantly greater (p < .001, r = .70) for the Experimental Group.
Compared with Control Group #1, on the Nottingham Leisure Questionnaire, frequency of all activities was significantly greater (p < .001, r = .60) and number of activities engaged in was significantly greater (p < .001, r = .69) for the Experimental Group. The overall effect size of the Experimental treatment was r = .64, a large effect.
- There was no significant difference between Control Groups #1 and #2 on the Nottingham Leisure Questionnaire. Average effect r = .027.
- Compared with Control Groups #1 and #2, on the Nottingham Health Profile (psychological well-being), the Experimental Group scored significantly better (p = .0002, r = .39; p = .0011, r = .34, respectively).
- There were no significant differences among groups on the Wakefield Depression Inventory (r = .13).
- There was no significant difference among groups on the total score of the Nottingham Extended ADL Scale score. On the Mobility subscale, the Experimental Group scored significantly higher than Control Group #1 (p < .01, r = .49) and Control Group #2 (p < .001, r = .38). On the Leisure subscale, the Experimental Group scored significantly better than Control Group #1 (p < .005), r = .45) or Control Group #2 (p < .0025, r = .43). The mean effect size was r = .44.
Within Groups/Conditions/Times: Not Tested
THREATS TO VALIDITY
Possible sampling bias (experimental group was younger). Using ANCOVA to try to statistically control for this was inappropriate.
Although the assessments were conducted by an independent assessor who was blind to the group allocation, both the leisure and conventional OT groups were seen by the same therapist. Therefore, if the therapist was not blind to the hypothesis, the findings might be confounded.
The findings suggest that providing a leisure rehabilitation program for stroke patients does increase leisure participation, as well as mobility and psychological well being, but not mood.
This study suggests that OT could enhance stroke patients' leisure participation by providing interventions directly related to their leisure pursuits. In addition, the leisure interventions may improve the patients' mobility and psychological well-being. On the other hand, the effectiveness of conventional OT intervention is very small.
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.
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