Stroke Structured Abstract - S #6
Practice in dressing may improve stroke patients' dressing skills
CITATION: Walker, M. F., Drummond, A. E. R, & Lincoln, M. B. (1996). Evaluation of dressing practice for stroke patients after discharge from hospital: A crossover design. Clinical Rehabilitation, 10, 23-31.
LEVEL OF EVIDENCE: IC1b
What is the effectiveness of dressing practice for stroke patients after discharge from hospital?
Randomized controlled trial (RCT) (Two-group randomized crossover design)
Patients were randomly assigned to one of two groups: Group 1, which received no intervention followed by 3 months of treatment, or Group 2, which received the opposite sequence of treatment.
SAMPLING PROCEDURE/INCLUSION CRITERIA
Patients who had been discharged from the general medical, health care of the elderly, and stroke units of Nottingham Hospital (Nottingham, United Kingdom) were considered for inclusion.
Inclusion criteria were patients at home with problems in dressing 6 months after acute stroke. Excluded were patients who were blind, deaf, did not speak or understand English, or had a history of dementia. Any preexisiting physical difficulties did not preclude patients from participating in the study.
N = 30
Male = 16
Female = 14
Mean age = 68
LCVA = 16
RCVA = 14
Attrition = NR
NR = Not Reported
(R = Reliability established; V = Validity established)
Nottingham Dressing Assessment - R
Rivermead ADL (self-care) - R
Nottingham Health Profile - R
Experimental phase: Treatment involved teaching patients and caregivers appropriate techniques such as dressing the affected limb first, energy conservation, use of red thread to overcome unilateral neglect and to mark alignment of buttons, and advice on choice of clothing.
Control phase: No treatment; no contact with the research occupational therapist.
WHO DELIVERED INTERVENTION
Senior (research) OT
FREQUENCY & DURATIONRESULTS
Dressing practice was given on a regular basis, with the amount of therapy at the therapist's discretion.
Duration was 6 months.
There was significant improvement during the treatment phase compared with the control phase for:
Nottingham Dressing Assessment (p = .002, r = .53)
Rivermead ADL (p = .008, r = .44)
Nottingham Health Profile (p = .025, r = .36).
There was no change during the nontreatment phase.
Patients who received treatment in the first 3 months maintained their improvement at 6 months after admission to the study (~12 months poststroke).
Within Groups/Conditions/Times: NR
THREATS TO VALIDITY
None. The only flaw of the study is that the therapist determined the amount of service for each patient instead of the number of interventions being controlled.
Dressing practice given at home to patients who have residual problems in dressing 6 months after acute stroke leads to sustained reduction of their problems.
The findings suggest the effectiveness of dressing practice for stroke patients. They also suggest that stroke patients have potential for improving their dressing skills as much as 12 months poststroke, and that therapy for this population is important.
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.