Systematic review of hospital-based interventions to improve post-stroke independence in activities of daily living.

INTRODUCTION

Early after stroke, inpatients commonly experience difficulty performing activities of daily living (ADL). Occupational therapists are key to providing early rehabilitation to optimise recovery. However, the effectiveness of early, activity-based retraining of ADLs is not clear. The aim of this systematic scoping review is to determine whether activity-based retraining targeting basic activities of daily living (b-ADL) and/or simple cognitive instrumental activities of daily living (C-IADL) delivered early after stroke improves functional independence.

METHODS

MEDLINE, CINAHL, and Embase were searched. Eligible studies included randomised controlled trials or quasi-randomised trials, with at least 75% of participants over the age of 18, with a stroke diagnosis, and who received activity-based interventions within the hospital setting. Articles were screened by two authors using Covidence. Risk of bias was assessed using Cochrane's Risk of Bias tool (RoB2). All results were meta-analysed using Comprehensive Meta Analysis software (V4.0).

CONSUMER AND COMMUNITY INVOLVEMENT: No consumer or community involvement was included in this study.

RESULTS

A total of 7546 articles were screened, and six studies including n = 254 participants met the inclusion criteria. Performance outcome measure results were meta-analysed; there was no statistically significant impact of activity-based interventions on functional performance (standardised mean difference [SMD] = 0.41; 95% confidence interval [CI] -0.06, 0.87; P = 0.09). Two studies reviewed quality of life and satisfaction outcomes; data were not synthesised.

CONCLUSION

Whereas individual trials suggested improvements early after activity-based training, our meta-analysis showed variability in effects in trials to date. Further research is required to determine the clinical and cost-effectiveness of activity-based interventions within the hospital setting to guide occupational therapy practice.