Occupational therapy for cognitive impairment in stroke patients: Cochrane systematic review

Abstract

Assessed as up to date: 2009/07/16

Background

Cognitive impairment is a frequent consequence of stroke and can impact on a person's ability to perform everyday activities. There are a number of different intervention strategies that occupational therapists may use when working with people who have cognitive impairment post-stroke.

Objectives

To determine whether occupational therapy improves functional performance of basic activities of daily living (ADL) and specific cognitive abilities in people who have cognitive impairment following a stroke.

Search methods

We searched the Cochrane Stroke Group Trials Register (last searched May 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to April 2009), EMBASE (1980 to April 2009), CINAHL (1982 to April 2009), PsycINFO (1840 to April 2009), PsycBITE, OTseeker and Dissertation Abstracts (the latest three were searched up to April 2009). In an effort to identify further published, unpublished, and ongoing trials, we also tracked relevant references through the cited reference search in Science Citation Index (SCI) and Social Science Citation Index (SSCI), reviewed the reference lists of relevant studies and reviews, handsearched relevant occupational therapy journals, and contacted key researchers in the area.

Selection criteria

Randomised and quasi-randomised controlled trials that evaluated an intervention focused on providing cognitive retraining to adults with clinically defined stroke and confirmed cognitive impairment. The intervention needed either to be provided by an occupational therapist or given under the supervision of an occupational therapist.

Data collection and analysis

Two review authors independently examined the abstracts that might meet the inclusion criteria, assessed the quality and extracted data. We have presented results using mean differences.

Main results

We included one trial with 33 participants in this review. We found no difference between groups for the two relevant outcomes that were measured: improvement in time judgement skills and improvement in basic ADLs on the Barthel Index.

Authors' conclusions

The effectiveness of occupational therapy for cognitive impairment post-stroke remains unclear. The potential benefits of cognitive retraining delivered as part of occupational therapy on improving basic daily activity function or specific cognitive abilities, or both, of people who have had a stroke cannot be supported or refuted by the evidence included in this review. More research is required.

Author(s)

Hoffmann Tammy, Bennett Sally, Koh Chia-Lin, McKenna Kryss T

Summary

Occupational therapy for cognitive impairment in stroke patients

Cognitive impairment is common after stroke and can affect a person's ability to do everyday activities such as dressing, feeding, and showering. Occupational therapy aims to help people reach their maximum level of functional independence. This review of one trial including 33 participants found that there is currently insufficient evidence to establish the effectiveness of occupational therapy for cognitive impairment in people who have had a stroke. More well-designed clinical trials which test occupational therapy interventions for cognitive impairment post-stroke are needed.

Reviewer's Conclusions

Implications for practice

The effectiveness of occupational therapy for cognitive impairment post-stroke remains unclear. The potential benefits of cognitive retraining delivered as part of an occupational therapy service on improving basic daily activity function or specific cognitive abilities, or both, of people who have had a stroke cannot be supported or refuted by evidence from the reviewed RCT.

Implications for research

In order to obtain reliable and valid evidence of the effect of occupational therapy for cognitive impairment post-stroke further methodologically rigorous investigations using RCTs are needed. The included study must be viewed in the light of its small sample size. Future studies should aim to have larger numbers of participants.

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