Occupational therapy is effective in improving independence in stroke patients

Occupational therapy can improve the lives of patients who have suffered a stroke and lessen their chances of deteriorating or even dying, according to an international study published in the British Medical Journal Online.

A systematic review of randomised trials, carried out by University of Nottingham academics alongside others in the UK, Canada and the Netherlands, suggests that patients who undergo occupational therapy retain significantly more independence than those who do not.

This allows them to carry out more everyday tasks without help and lead a more independent life after stroke.

More than 140,000 people suffer from a stroke in the UK every year — which equates to one every five minutes. According to the Stroke Association, stroke has a greater disability impact than any other chronic disease, with 300,000 people living with moderate to severe disabilities as a result.

Six months after a stroke approximately half of survivors are dependent on others to help them carry out everyday tasks such as eating, dressing and going to the toilet.

Researchers in the latest study looked at nine randomised controlled trials with a total group size of 1,258 people and mean age range from 55 to 87.5 years. The exact nature of the interventions differed according to the type of patient due to the complex nature of occupational therapy. But all the trials compared an occupational therapy intervention which focused on the activities of daily living with a control group where there was no routine intervention.

Occupational therapy is defined as the use of purposeful activity designed to achieve outcomes which promote health, prevent injury or disability and which develop, improve or restore the highest possible level of independence.

The researchers focused on occupational therapy intended to improve self-care, for example washing, dressing, eating and using the toilet in people who had had a stroke. They then used validated measures of performance in these areas to compare levels of independence and ability between patients had undergone occupational therapy and those who had not.

They found that patients who had had occupational therapy after a stroke were significantly more independent and able to carry out everyday tasks. The odds of a poor outcome — such as dependency on others, deterioration or death — were also significantly lower.

The report authors said: “Occupational therapy after stroke ‘works’, in that it improves outcome in terms of ability in personal activities of daily living.”

The results support the conclusion that focused occupational therapy should be available to everyone who has had a stroke, they said. But further work is needed to define which individuals are most likely to benefit from occupational therapy and which specific interventions are the most effective.

The research team at The University of Nottingham was led by Dr Avril Drummond and included Dr Jo Leonardi-Bee, Professor John Gladman, Dr Judi Edmans, Dr Pip Logan and Dr Marion Walker.

The other institutions involved were: University of Glasgow; University of Northampton; Erasmus University Medical Centre, Rotterdam; Royal Haslar Hospital, Gosport; University of British Columbia, Canada; and the University of Birmingham.