Structured Abstract
Stroke Structured Abstract - S #4
Functional treatment may be as beneficial as sensorimotor integration
CITATION: Jongbloed, L., Stacey, S., & Brighton, C. (1989). Stroke rehabilitation: Sensorimotor integrative treatment versus functional treatment. American Journal of Occupational Therapy, 43, 391-397.
LEVEL OF EVIDENCE: IB2b
RESEARCH QUESTION
How does the effectiveness of two OT approaches to treatment of stroke patients-the functional and sensorimotor integrative approaches-differ?
DESIGN
Randomized controlled trial (RCT)
Subjects were randomly assigned to one of two groups: Sensorimotor Integrative or Functional.
SAMPLING PROCEDURE/INCLUSION CRITERIA
Subjects were admitted to Holy Family Hospital in Vancouver, British Columbia, Canada, between August 1985 and November 1986.
To be included, the patients must: (a) have been admitted to the hospital within 12 weeks after a first cerebral vascular accident (CVA); (b) have a weakness in the upper and lower extremities on one side of the body on admission; (c) not have resided in an extended care setting before the stroke; and (d) not have severe aphasia.
SAMPLE
|
N = 90 |
Male = 41 |
Female = 49 |
Mean age = 71.3 |
|
LCVA = 44 |
RCVA = 46 |
Attrition = NR |
|
x |
Acute |
|
Chronic |
NR = Not Reported
OUTCOME MEASURES
(R = Reliability established; V = Validity established)
Barthel Index - R, V
Meal Preperation - Reliability and validity not established
Eight Sensorimotor integration tests - R, V
INTERVENTION DESCRIPTION
Group 1: Functional Approach: Emphasizes the practice of tasks, usually activities of daily living (ADL). The emphasis is on treatment of the symptom rather than on the cause of the dysfunction. Two methods are used: compensation and adaptation.
Group 2: Sensorimotor Integrative Approach: Emphasizes treating the cause of the dysfunction rather than compensating for, or adapting to, the problem. The principles that guided treatment were: (a) provide planned and controlled sensory input; (b) elicit an adaptive response; (c) enhance organization of brain mechanisms; and (d) facilitate the developmental sequence.
WHO DELIVERED INTERVENTION
OT
SETTING
Clinics
FREQUENCY & DURATION
40 minutes per day, 5 days a week, for 8 weeks.
RESULTS
Between Groups/Conditions/Times:
There was no significant difference between the two groups on any of the outcome measures.
Within Groups/Conditions/Times:
Both groups improved significantly (p < .05) over time on the Barthel Index, Meal Preparation, and six out of eight subtests of the Sensorimotor Integrative Test Battery. Effect sizes could not be calculated from the information supplied.
THREATS TO VALIDITY
Cointervention: All subjects received similar treatment for morning and evening self-care and Bobath NDT treatment in physical therapy.
Spontaneous recovery is an alternate explanation for the improvement seen in both groups.
AUTHORS' CONCLUSIONS
The authors concluded that if there are any differences between functional treatment and sensorimotor integrative treatment they are small. The findings suggest that occupational therapists can consider using either approach in planning treatment for CVA patients.
REVIEWERS' CONCLUSIONS
This study suggests that the functional approach is as beneficial as the sensorimotor integrative approach.
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.
