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RESEARCH: Lynn Legg, Avril Drummond, Jo Leonardi-Bee, J R F Gladman, Susan Corr, Mireille Donkervoort, Judi Edmans, Louise Gilbertson, Lyn Jongbloed, Pip Logan, Catherine Sackley, Marion Walker, and Peter Langhorne Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials BMJ 2007; 335: 922 [Abstract] [Full text]

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Occupational therapy post-stroke

Vanessa J Abrahamson   (7 November 2007)

Occupational therapy post-stroke 7 November 2007
Vanessa J Abrahamson, Researcher Dept Epidemiology & Public Health, UCL, 1-19 Torrington Place, London WC1E 6BT Send response to journal: Re: Occupational therapy post-stroke	Some amplification of McPherson and Ellis-Hill’s valuable systematic review of occupational therapy services post-stroke may hopefully be useful, based on experience in stroke units in Britain and New Zealand (MSc dissertation, London School of Hygiene & Tropical Medicine, 2006): • Too narrow a focus on self-care skills as a key indicator for discharge can result in insufficient attention to areas that patients identify as important, for example re-establishing their role within the family and re-engaging in meaningful activities. • Occupational therapy needs to be part of an interdisciplinary approach that fully involves all staff, including auxiliaries, patients, family and friends. • The systematic review was unable to draw conclusions about patient (and carer) mood and quality of life. However, early recognition of mood disorders is critical to effective rehabilitation: untreated progress can be severely impeded(1). Many stroke units do not have sufficient, if any, access to clinical psychology, neuropsychology, and psychiatry. • The authors comment that further work is needed to identify which patients can benefit most from therapy. Unfortunately, many under- resourced and under-staffed departments face the demoralising necessity of prioritising those with the most potential at the expense of others who are likely to make important, though lesser, gains. Six studies used the Barthel index, a crude indicator of improvement, not designed to detect subtle improvements that can be of importance to quality of life. • Community stroke teams are well placed to continue rehabilitation but need experienced staff with sufficient time and resources. Patients can and do improve beyond the often cited 6 months post-stroke, but follow -up is often too short-term. This contrasts with the continuity of care provided in certain areas of New Zealand where patients are supported for as long as required by a co-ordinated network of services that includes vocational rehabilitation. • Occupational therapists are excellently placed to promote health and well-being for patients and carers post-stroke(2), including ethnic minority groups, in line with national policy(3-6). This again needs a team approach that lasts well beyond the initial inpatient phase. References 1. Barker-Collo SL. Depression and anxiety 3 months post stroke: prevalence and correlates. Arch Clin Neuropsychol 2007;22:519-31. 2. Scriven A. Health promotion practise: the contribution of nurses and allied health professionals. Basingstoke: Palgrave Macmillan, 2005. 3. Intercollegiate Stroke Working Party. National clinical guidelines for stroke. 2nd ed. London: Royal College of Physicians, 2004. 4. Department of Health. National Service Framework for Older People. London: The Stationery Office, 2001 5. Department of Health. Choosing Health: Making healthy choices easier. London: The Stationery Office, 2004. 6. Department of Health. Our health, our care, our say: a new direction for community services. London: The Stationery Office, 2006. Competing interests: None declared