Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Occupational therapy intervention after stroke
- Elliot F Epstein (14 December 2004)
-
Author's reply to Dr Epstein and a correction
- John R Gladman (16 December 2004)
|
|
|||
|
Elliot F Epstein, Specialist Registrar, Geriatric and General Medicine Walsall Manor Hospital, WS2 2PS
Send response to journal:
|
The study by Logan el al 1 reported that an occupational therapy intervention programme in the community improves outdoor mobility for patients following stroke. There is, however, insufficient comment by the authors of the potential detrimental effects of this approach. In particular, it is possible that patients in the intervention group may be at an increased risk of a fall, consequent upon mobilising outdoors, and the associated catastrophic complications such as fractured neck of femur. Conversely, the risk of a fall may be decreased following occupational therapy intervention. The frequency of falls in both intervention and control groups are not reported in this study but this would be useful information. Another issue that deserves comment is that the main outcome measure in this study is whether the patient feels able to go out of the house as often as desirable. Could it not be possible that, following occupational therapy intervention and goal setting, patients are more likely to develop realistic expectations of their degree of disability hence will answer favourably to this question? Despite the aforementioned issues, we do feel that this is important study. Community-based occupational therapy, as part of a multidisciplinary team intervention programme, should be widely available to appropriate patients after stroke. 1 P A Logan, J R F Gladman, A Avery, M F Walker, et al. Randomised controlled trial of an occupational therapy intervention to increase outdoor mobility after stroke BMJ 2004; 329: 1372-1375 Competing interests: None declared |
|||
|
|
|||
|
John R Gladman, Reader, Medicine of Older People University of Nottingham, UK
Send response to journal:
|
In response to Dr Epstein's first point in his rapid response to our paper, we agree that it would have been interesting to have collected information on falls. We think it very unlikely that the intervention led to significant catastrophic events such as falls leading to hip fracture, or if they did they were still outweighed by the benefits, given the huge benefits seen using intention to treat analysis. We take his point that we may have provided an effective falls reduction intervention. In response to Dr Epstein's second point, not only did we find that more participants given the intervention got out of the house as much as they wanted, but they also reported going out far more often (see Table 2) and Figure 2 showed a significant increase in mobility in the intervention group (using the Nottingham Extended ADL mobility scale). Therefore, we think it very unlikely that the benefits were achieved by lowering expectations, but that they were achieved by increasing outdoor mobility. Since the paper was published, I am grateful to the eagle-eyed Klaus Eichler from Zurich, who spotted a minor error in Table 2, which will shortly be corrected. In Table 2 the number and percentage of control group patients who did not get out of the house as much as they wanted at 4 months was 31 (38%) and not 30 (35%), and at 10 months it was 29 (35%) and not 33 (38%). All other values in the table are correct. This was a simple transcription error and was my mistake. I apologise to readers and the BMJ for this. Fortunately, this minor error makes no difference to the rest of the paper, or to its value. Competing interests: None declared |
|||