Table 1.
Description of trials included in review*
| Study (setting) | Sample size, characteristics, and theoretical framework (if specified) | Intervention and time scale | Outcomes | Baseline differences |
|---|---|---|---|---|
| Corr 1995w17 (UK hospital outreach) | 110 patients: 55 intervention, 55 control. Mean age 75.5, 37% men. Median Barthel index score at baseline: intervention 15 (IQR 2-20), control 14 (0-20). Clinical definition of stroke. Patients recruited before discharge from inpatient facility. Inclusion criteria: discharged alive from one of two stroke units regardless of discharge destination. Model of human occupation | Rehabilitation at home by occupational therapists versus usual care. Interventions included: teaching new skills; facilitating more independence in activities of daily living; facilitating return of function; enabling patients to use equipment supplied by other agencies; information provision to patient and carer; referring to or liaison with other agencies. Service provided by a qualified occupational therapist. Input at 2, 8, 16, and 24 weeks over 12 months, 95.5% followed up | Death, Barthel index, Nottingham extended ADL index, Geriatric depression scale (short form), Pearlman's 6 point quality of life scale. Carer: Pearlman's 6 point qualify of life scale | More women in intervention group (P=0.03) |
| Gilbertson 2000w18 (UK hospital outreach) | 138 patients: 67 intervention, 71 control. Median age 69, 45% men. Median Barthel index at baseline: intervention 17 (15-18), control 18 (16-19). Clinical definition of stroke. Patients recruited when discharged from hospital/date set. Inclusion criteria: discharged to private address; willing to cooperate; consent. Exclusion: made full recovery; discharged to institutional care; terminally ill; lived outside catchment area; severe cognitive or communication difficulties preventing consent, goal setting or completing outcome measures. Model of occupational performance | Domiciliary occupational therapy versus routine service. Domiciliary occupational therapy for a period of six weeks. Client-centred occupational therapy programme. Liaison with other agencies. Occupational therapy provided by a qualified occupational therapist. About 1.7 visits/week for 30-45 min over 6 months; 96.4% followed | Outcomes recorded at 7 weeks and 6 months. Primary outcomes: Nottingham extended ADL index; Barthel index; “Global” (death or deterioration) in Barthel index score. Secondary outcomes: Barthel index; Canadian occupational performance measure; EuroQol; satisfaction with outpatient services; resource use (staff time, hospital readmission, provision of equipment and services). Carer: general health questionnaire at 6 weeks | Favour control group |
| Chiu 2004w19 (Hong Kong hospital outreach) | 53 patients: 30 intervention, 23 control. Mean age 72.1, 66% men. Barthel index at baseline: NA. Definition of stroke: unclear. Recruitment: inpatients and outpatients discharged from hospital for <2 weeks. Inclusion criteria: aged >55, diagnosis of stroke, able to follow instructions, able to communicate using speech, family support at home, required bathing device | Additional home based training intervention on the use of bathing devices versus no intervention. 2-3 visits intervention group over 3 months; 100% followed | Outcomes recorded 3 months after discharge. Primary outcome: NS. Outcome measures: functional independence measure (FIM); users evaluation of satisfaction with assistive technology | None |
| Drummond 1995w20 (UK community) | 65 patients: 42 intervention (21 in leisure intervention group, 21 in ADL intervention group), 23 control. Mean age 66, 57% men. Barthel index at baseline: not collected. Definition of stroke: unclear. Patients recruited at discharge from inpatient facility. Inclusion criteria: admitted to hospital stroke unit. Exclusion criteria: severe comprehension difficulties (score <3 on Boston diagnostic aphasic examination); documented history of dementia; no English language | Leisure versus conventional occupational therapy versus no occupational therapy. Leisure intervention: patients hobbies and interests were discussed in detail and the importance of maintaining a leisure programme stressed. Treatment reflected personal preferences and abilities. Help and advice included: treatment (eg practice of transfers and dressing practice needed for leisure pursuits); positioning; provision of equipment; adaptations; advice on obtaining financial assistance and transport; liaison with specialist organisations; and providing physical assistance. Conventional OT: OT activities such as transfers, washing and dressing practice, and when appropriate, perceptual treatments. Patients seen by OT for minimum of 30 min/week for 3 months, then 30 min/every 2 weeks up to 6 months; 98.5% followed | Outcomes recorded at 3 and 6 months. Nottingham extended ADL index. Nottingham health profile. Nottingham leisure questionnaire. Wakefield depression inventory | Favour leisure group |
| Walker 1996w21 (UK community) | 30 patients: 15 intervention, 15 control. Mean age 68, 53% men. Barthel index at baseline: not collected. Definition of stroke: unclear. Patients recruited at discharge from inpatient facility. Exclusion criteria: blind, deaf, unable to understand or speak English before stroke | Domiciliary occupational therapy versus no occupational therapy intervention. Domiciliary occupational therapy over a three month period provided by a senior occupational therapist. Components of intervention: dressing practice on a regular basis; teaching patients and carers specific dressing techniques, energy conservation techniques, advice on clothing adaptation. Relative/carer involvement in therapy programme and “homework” between therapy sessions. Occupational therapy provided by a qualified occupational therapist. Amount of therapy provided at therapist's discretion. Mean 6 visits over 6 months; 100% followed | Outcomes recorded at 3 and 6 months. Nottingham stroke dressing assessment. Rivermead ADL scale. Nottingham health profile | None |
| Logan 1997w22 (UK community) | 111 patients: 53 intervention, 58 control. Mean age 55, 43% men. Barthel index at baseline: NA. Clinical definition of stroke. Inclusion criteria: first stroke and discharged from hospital and referred to social services occupational therapy department | Enhanced occupational therapy service versus usual care. Enhanced (dedicated, prompt, and intensive) occupational therapy service provided by social services, includes provision of equipment and appliances. Occupational therapy provided by a qualified occupational therapist. Single therapist. Duration 6 months; 85.6% followed | Outcomes recorded at 3 and 6 months. Nottingham extended ADL index. Barthel index. General health questionnaire. Carer: general health questionnaire | None |
| Walker 1999w23 (UK community) | 185 patients: 94 intervention, 91 control. Mean age 74; 51% men. Median Barthel index at baseline: intervention 18 (15-20); control 18 (15- 20). Clinical definition of stroke. Patients recruited <1 month after stroke onset from home. Exclusion criteria: >1 month after stroke onset, history of dementia, living in nursing or residential home, unable to speak or understand English before stroke | Occupational therapy versus no occupational therapy. Occupational therapy intervention for a period of five months. Aim of therapy was to achieve independence in personal (bathing, dressing, feeding, stair mobility) and instrumental activities of daily living (outdoor mobility, driving a car, using public transport, household chores). Homework tasks were set in between therapy sessions. Occupational therapy provided by a qualified occupational therapist. Single therapist. Frequency of visits arranged between therapist, patient, and carer (if appropriate). Mean of 5.8 visits/patient over 6 months; 95.1% followed | Outcomes recorded at 6 months. Primary outcomes: Nottingham extended ADL index; Barthel index | Favour intervention group |
| Sackley 2006w24 (UK community nursing home | 12 nursing homes. 118 residents: 63 intervention, 55 control. Mean age 87.5, 19% men. Mean Barthel index at baseline: intervention 10.1 (SD 5.68); control 9.49 (5.2). Definition of stroke: unclear. Inclusion criteria: Barthel <15. No specific approach | Occupational therapy versus standard care. Occupational therapy included activities of daily living practice, mobility practice, assessment and goal setting, communication with residents, staff, relatives, and other agencies, adaptive equipment and treatment of impairments. Mean visits 8.5, mean total time 4.7 hours/patient over 6 months; 100% followed | Outcomes recorded at 3 and 6 months. Primary outcome: Barthel index | None |
| Parker 2001w25 (UK hospital outreach) | 466 patients: 309 intervention (153 in leisure group; 156 in ADL group), 157 controls. Median age 72, 71, 72. Median Barthel index at baseline: leisure 18 (15-19); ADL 18 (16-20); control 18 (16-19), 58% men. WHO definition of stroke. Patients recruited from one of four participating sites at discharge. All attending stroke outcome clinic (site 5) with stroke onset <6 months. Exclusion criteria: discharge to a nursing or residential home, recorded history of dementia, inability to complete outcome questionnaires because of limited use of English, unable to endure interventions because co-morbidity, lived outside catchment area | OT leisure v ADL v no OT for up to 6 months after recruitment. Leisure group: goals were set in terms of leisure activities as well as ADL tasks to achieve leisure objectives. ADL group: goals set to improve independence in self care activities and included practice in activities such as meal preparation and walking outdoors. Control group: no OT. OT provided by qualified therapist. At least 10 sessions, each at least 30 min/patient over 12 months; 79% followed | Outcomes recorded at 6 (primary) and 12 months. Primary outcome measure: general health questionnaire 12 item; Nottingham leisure questionnaire; Nottingham extended ADL index. Secondary outcomes: international stroke trial outcome questions; Rankin scale; Oxford handicap scale; Barthel index; London handicap scale. Carer: general health 12 item questionnaire | None |
IQR=interquartile range, NS=not stated, NA=not available, OT=occupational therapy, ADL=activities of daily living.
*Unit of randomisation and analysis was individual except in w24, which was nursing home with individual adjusted for clustering.