Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and inconsistency (heterogeneity in patients and interventions).
A Cochrane review [Abstract] 1 included 9 studies with a total of 995 subjects. All studies included adult stroke patients who received occupational therapy following discharge from hospital. Mean age of participants ranged from 55 to 87.5 years. The comparison groups were described as no intervention, no occupational therapy and usual care. Occupational therapy targeted towards activities of daily living (ADL) after stroke increased performance scores (SMD 0.17, 95% CI 0.03 to 0.31, P = 0.02; 7 studies, n=749) and reduced the risk of poor outcome (death, deterioration or dependency in personal ADL) (OR 0.71, 95% CI 0.52 to 0.96; 5 studies, n= 771). We also found that those who received occupational therapy were more independent in extended ADL (OR 0.22, 95% CI 0.07 to 0.37; 5 studies, n=665). Occupational therapy did not influence mortality (OR: 1.02, 95% CI 0.65 to 1.61; 8 studies, n=950), or reduce the combined odds of death and institutionalisation (OR 0.89, 95% CI 0.60 to 1.32; 4 studies, n= 671), or death and dependency (OR 0.89, 95% CI 0.64 to 1.23; 4 trials, n=659). Occupational therapy did not improve mood or distress scores (OR 0.08, 95% CI -0.09 to 0.26; 4 studies, n=519). There were insufficient data to determine the effects of occupational therapy on health-related quality of life. There were no carer-related outcomes in the review.
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