Occupational therapy for stroke patients not admitted to hospital: a randomised controlled trial. A multicentre randomized controlled trial of leisure therapy and conventional occupational therapy after stroke. TOTAL Study Group. Trial of Occupational Therapy and Leisure. An investigation of involvement in leisure activities after a stroke. Cluster randomized pilot controlled trial of an occupational therapy intervention for residents with stroke in UK care homes. Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial. A randomized controlled trial of enhanced Social Service occupational therapy for stroke patients. The effectiveness of community-based rehabilitation for stroke patients who remain at home: a pilot randomized trial. Effectiveness of an intensive outpatient rehabilitation program for postacute stroke patients. The significance of intensity of rehabilitation of stroke--a controlled trial.
Patients who have a stroke are not always admitted to hospital, and 22-60% remain in the community, frequently without coordinated rehabilitation. We aimed to assess the efficacy of an occupational therapy intervention for patients with stroke who were not admitted to hospital.
                In this single-blind randomised controlled trial, consecutive stroke patients on a UK community register in Nottingham and Derbyshire were allocated randomly to up to 5 months of occupational therapy at home or to no intervention (control group) 1 month after their stroke. The aim of the occupational therapy was to encourage independence in personal and instrumental activities of daily living. Patients were assessed on outcome measures at baseline (before randomisation) and at 6 months. The primary outcome measure was the score on the extended activities of daily living (EADL) scale at 6 months. Other outcome measures included the Barthel index, the general health questionnaire 28, the carer strain index, and the London handicap scale. All assessments were done by an independent assessor who was unaware of treatment allocation. The analysis included only data from completed questionnaires.
                185 patients were included: 94 in the occupational therapy group and 91 in the control group. 22 patients were not assessed at 6 months. At follow-up, patients who had occupational therapy had significantly higher median scores than the controls on: the EADL scale (16 vs 12, p<0.01, estimated difference 3 [95% CI 1 to 4]); the Barthel index (20 vs 18, p<0.01, difference 1, [0-1]); the carer strain index (1 vs 3, p<0.05, difference 1 [0 to 2]); and the London handicap scale (76 vs 65, p<0.05, difference 7, [0.3 to 13.5]). There were no significant differences on the general health questionnaire between the patient or carer.
                Occupational therapy significantly reduced disability and handicap in patients with stroke who were not admitted to hospital. To evaluate the effects of leisure therapy and conventional occupational therapy (OT) on the mood, leisure participation and independence in activities of daily living (ADL) of stroke patients 6 and 12 months after hospital discharge.
                Multicentre randomized controlled trial.
                Four hundred and sixty-six stroke patients from five UK centres.
                The General Health Questionnaire (12 item), the Nottingham Extended ADL Scale and the Nottingham Leisure Questionnaire, assessed by post, with telephone clarification.
                Four hundred and forty (94%) and 426 (91%) subjects were alive at 6 and 12 months, respectively. Three hundred and seventy-four (85% of survivors) and 311 (78% of survivors) responded at 6 and 12 month follow-up respectively. At six months and compared to the control group, those allocated to leisure therapy had nonsignificantly better GHQ scores (-1.2: 95% CI -2.9, +0.5), leisure scores (+0.7, 95% CI -1.1, +2.5) and Extended ADL scores (+0.4: 95% CI -3.8, +4.5): the ADL group had nonsignificantly better GHQ scores (-0.1: 95% CI -1.8, +1.7) and Extended ADL scores (+1.4: 95% CI -2.9, +5.6) and nonsignificantly worse leisure scores (-0.3: 95% CI -2.1, +1.6). The results at 12 months were similar.
                In contrast to the findings of previous smaller trials, neither of the additional OT treatments showed a clear beneficial effect on mood, leisure activity or independence in ADL measured at 6 or 12 months. The purpose of this study was to determine the efficacy of occupational therapy intervention related to the leisure activities of stroke survivors. Forty discharged stroke patients were randomly assigned to an experimental group, which received occupational therapy intervention related to leisure activities, or to a control group. An independent evaluator assessed the patients' involvement in activities and satisfaction with that involvement on three separate occasions. The results showed no statistically significant differences between the experimental and control groups in activity involvement or satisfaction with that involvement. There are likely two reasons for these findings. First, the intervention was limited in scope (i.e., only five therapist visits), and second, many environmental factors strongly influence activity participation and satisfaction. A pilot evaluation of an occupational therapy intervention to improve self-care independence for residents with stroke-related disability living in care homes was the basis of this study.
                A cluster randomized controlled trial with care home as the unit of randomization was undertaken in Oxfordshire, UK. Twelve homes (118 residents) were randomly allocated to either intervention (6 homes, 63 residents) or control (6 homes, 55 residents). Occupational therapy was provided to individuals but included carer education. The control group received usual care. Assessments were made at baseline, postintervention (3 months) and at 6-months to estimate change using the Barthel Activity of Daily Living Index (BI) scores, "poor global outcome", (defined as deterioration in BI score, or death) and the Rivermead Mobility Index.
                At 3 months BI score in survivors had increased by 0.6 (SD 3.9) in the intervention group and decreased by 0.9 (2.2) in the control group; a difference of 1.5 (95% CI allowing for cluster design, -0.5 to 3.5). At 6 months the difference was 1.9 (-0.7 to 4.4). Global poor outcome was less common in the intervention group. At 3 months, 20/63 (32%) were worse/dead in the intervention group compared with 31/55 (56%) in the control group, difference -25% (-51% to 1%). At 6 months the difference was similar, -26% (-48% to -3%). Between-group changes in Rivermead Mobility Index scores were not significantly different.
                Residents who received an occupational therapy intervention were less likely to deteriorate in their ability to perform activities of daily living. To establish if a brief programme of domiciliary occupational therapy could improve the recovery of patients with stroke discharged from hospital.
                Single blind randomised controlled trial.
                Two hospital sites within a UK teaching hospital.
                138 patients with stroke with a definite plan for discharge home from hospital.
                Six week domiciliary occupational therapy or routine follow up.
                Nottingham extended activities of daily living score and "global outcome" (deterioration according to the Barthel activities of daily living index, or death).
                By eight weeks the mean Nottingham extended activities of daily living score in the intervention group was 4.8 points (95% confidence interval -0.5 to 10.0, P=0.08) greater than that of the control group. Overall, 16 (24%) intervention patients had a poor global outcome compared with 30 (42%) control patients (odds ratio 0.43, 0.21 to 0.89, P=0.02). These patterns persisted at six months but were not statistically significant. Patients in the intervention group were more likely to report satisfaction with a range of aspects of services.
                The functional outcome and satisfaction of patients with stroke can be improved by a brief occupational therapy programme carried out in the patient's home immediately after discharge. Major benefits may not, however, be sustained. To determine whether stroke patients referred to the Social Service occupational therapy service would benefit from an enhanced service compared to the usual service.
                Randomized controlled study allocating patients to the enhanced service or the usual service.
                Stroke patients discharged home from hospital and referred to Social Service occupational therapy department.
                The sections and total score from the Nottingham Extended Activities of Daily Living Scale (EADL), the Barthel Index, the General Health Questionnaire (GHQ) and the number of pieces of equipment provided were analysed.
                One hundred and eleven stroke patients were recruited to this study. Fifty-three were randomly allocated to the enhanced service and 58 to the usual service. Patients receiving the enhanced service were seen more quickly after referral, for longer, and received significantly more visits (p < 0.01) than those receiving the usual service. Three months after entry to the study the enhanced service group had better EADL (p < 0.01) than the usual service group. This benefit remained significant in only the mobility section of the EADL at six months. Careers of the stroke patients in the enhanced group had lower GHQ scores (p < 0.05) than those in the usual group at six months.
                This trial supports the use of domiciliary occupational therapy for stroke patients after discharge from hospital in terms of improvements in functional outcomes in the short term, but the long-term benefits remain unclear. To assess the effectiveness of community-based rehabilitation for stroke patients who were not admitted to hospital in South London.
                Randomized controlled trial.
                Patients' homes in South London.
                Stroke patients not admitted to hospital after a stroke.
                Rehabilitation at home by rehabilitation team for up to three months or usual care.
                The primary outcome measure was the Barthel score. Secondary measures included the Motricity Index, Rivermead ADL, Hospital Anxiety and Depression score and Nottingham Health Profile.
                Forty-three patients who remained at home were randomized to rehabilitation team (23) or 'usual' care (20). The mean number of physiotherapy sessions was three (range 1-14) for the rehabilitation team group and two for the usual care group. Patients (with a deficit) in the rehabilitation arm of the trial were more likely to receive occupational, physical and speech therapy than those in the control arm (p = 0.03, 0.01 and 0.008, respectively). For those patients actually receiving therapy, there was no evidence that the amount received differed between the groups. However, the number of patients in each of these comparisons was very small. The outcome for patients in the rehabilitation team arm of the trial was nonsignificantly higher (0.05 < p < 0.2) than for those in the control arm for the areas of Nottingham Health Profile, anxiety, depression, caregiver strain and the proportion of patients living at home. Based on the data observed here, a trial with approximately 150 patients in each arm would be needed to have adequate power to detect a 33% difference between intervention and control groups in these outcomes.
                Community therapy support for patients not admitted to hospital is feasible but to determine whether it is cost- or clinically effective would require trials of adequate size. The effectiveness of ongoing rehabilitation services for postacute stroke survivors is poorly documented. We designed a randomized control, single-blinded study to demonstrate the effectiveness of intensive outpatient therapy. The treatment intervention consisted of 1 hr each of physical and occupational therapy, four times per week, for 12 wk; therapy focused on neuromuscular facilitation and functional tasks. All subjects were screened before the therapies and after 3 mo and 9 mo. Forty-nine stroke survivors, who were at least l yr (mean, 2.9 yr) poststroke, were randomized with two treated patients to each control (no treatment supplied). All patients had received inpatient rehabilitation at the time of their acute stroke, but no patient had any ongoing therapy within the last 6 mo. The outcome measures included the Functional Independence Measure (FIM), Brunnstrom stages of motor recovery, timed mobility tasks, and the Jebson hand evaluation. We also evaluated the level of depression, self-esteem, and socialization. The treated patients demonstrated an improvement of 6.6 points over the 3 mo of therapy compared with only 1.5 points in the control group in the FIM motor score transformed using Rasch analysis. The change from time 0 to 3 mo was significant in the treated group but not in the controls. Treated patients maintained their gains at the 9-mo follow-up, and controls lost ground. The treated group improved in terms of socialization and self-esteem as evidenced by a lower Sickness Impact Profile, whereas the controls tended to get worse. There was a trend toward less depression, but this did not reach a P = 0.05 level of significance. This study demonstrates that significant functional gains can still be attained in the postacute stroke survivor, despite prior inpatient rehabilitation services. Of the 373 stroke patients 95 were admitted to the feasibility study of stroke rehabilitation. The patients were divided into two groups, an intensive and a normal treatment group. In this study, the functional recovery of stroke, measured by ADL and motor function was significantly better in the intensive treatment group. There was no difference in institutionalization or incidence of death between the groups. The gain of ADL and motor function was greatest during the first three months after stroke in the intensive treatment group. The conclusion is that intensified physiotherapy seems to improve the functional recovery of stroke patients.
We found insufficient evidence to support or refute the efficacy of occupational therapy interventions for improving, restoring or maintaining independence in ADL for stroke survivors residing in care homes. The effectiveness of occupational therapy for the population of stroke survivors residing in care homes remains unclear, and further research in this area is warranted.