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Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials

BMJ 2007; 335 doi: (Published 01 November 2007) Cite this as: BMJ 2007;335:922
  1. Lynn Legg, CSO research training fellow1,
  2. Avril Drummond, principal research fellow in rehabilitation3,
  3. Jo Leonardi-Bee, lecturer in medical statistics2,
  4. J R F Gladman, professor of medicine of older people3,
  5. Susan Corr, reader in occupational science4,
  6. Mireille Donkervoort, senior researcher department of rehabilitation medicine5,
  7. Judi Edmans, research occupational therapist3,
  8. Louise Gilbertson, clinical specialist occupational therapist in stroke6,
  9. Lyn Jongbloed, associate professor7,
  10. Pip Logan, principal research fellow3,
  11. Catherine Sackley, professor of physiotherapy research8,
  12. Marion Walker, associate professor and reader in stroke rehabilitation and associate director UK stroke research network3,
  13. Peter Langhorne, professor of stroke care1
  1. 1Academic Section of Geriatric Medicine, Glasgow Royal Infirmary University NHS Trust, Glasgow G31 2ER
  2. 2Division of Epidemiology and Public Health, Clinical Sciences Building, City Hospital Campus NHS Trust, Nottingham NG5 1PB
  3. 3Division of Rehabilitation and Ageing, Medical School, Queen's Medical Centre, Nottingham
  4. 4Division of Occupational Therapy, School of Health, University of Northampton, Northampton NN2 7AL
  5. 5Erasmus University Medical Centre, Postbus 2040, 3000 CA, Rotterdam, Netherlands
  6. 6Occupational Therapy Service, Royal Haslar Hospital, Gosport PO12 2AA
  7. 7Department of Occupational Science And Occupational Therapy, UBC School of Rehabilitation Sciences, Online Programs, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
  8. 8Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT
  1. Correspondence to: L Legg step{at}
  • Accepted 30 July 2007


Objective To determine whether occupational therapy focused specifically on personal activities of daily living improves recovery for patients after stroke.

Design Systematic review and meta-analysis.

Data sources The Cochrane stroke group trials register, the Cochrane central register of controlled trials, Medline, Embase, CINAHL, PsycLIT, AMED, Wilson Social Sciences Abstracts, Science Citation Index, Social Science Citation, Arts and Humanities Citation Index, Dissertations Abstracts register, Occupational Therapy Research Index, scanning reference lists, personal communication with authors, and hand searching.

Review methods Trials were included if they evaluated the effect of occupational therapy focused on practice of personal activities of daily living or where performance in such activities was the target of the occupational therapy intervention in a stroke population. Original data were sought from trialists. Two reviewers independently reviewed each trial for methodological quality. Disagreements were resolved by consensus.

Results Nine randomised controlled trials including 1258 participants met the inclusion criteria. Occupational therapy delivered to patients after stroke and targeted towards personal activities of daily living increased performance scores (standardised mean difference 0.18, 95% confidence interval 0.04 to 0.32, P=0.01) and reduced the risk of poor outcome (death, deterioration or dependency in personal activities of daily living) (odds ratio 0.67, 95% confidence interval 0.51 to 0.87, P=0.003). For every 100 people who received occupational therapy focused on personal activities of daily living, 11 (95% confidence interval 7 to 30) would be spared a poor outcome.

Conclusions Occupational therapy focused on improving personal activities of daily living after stroke can improve performance and reduce the risk of deterioration in these abilities. Focused occupational therapy should be available to everyone who has had a stroke.


  • This study was done as a Cochrane systematic review under the auspices of the Cochrane Stroke Group, whose invaluable assistance is gratefully acknowledged.

  • Contributors: LL and AD planned the review. LL was lead reviewer and produced the first draft of the paper. AD, PLa, JL-B, and JRFG all collaborated on the final version before initial submission and took responsibility for the submitted version of the paper. SC, MD, JE, LG, LJ, PLo, CS, and MW were members of the occupational therapy trialists and obtained primary data and assisted in the editing of the paper. LL is guarantor.

  • Funding: The Big Lottery Fund and Chest Heart and Stroke Scotland funded staff time.

  • Competing interests: None declared.

  • Ethical approval: Not required.

    Provenance and peer review: Not commissioned; externally peer reviewed.

  • Accepted 30 July 2007
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