Matches in SemOpenAlex for { <https://semopenalex.org/work/W4225607566> ?p ?o ?g. }
- W4225607566 abstract "Cognitive impairment is a frequent consequence of stroke and can impact on a person's ability to perform everyday activities. Occupational therapists use a range of interventions when working with people who have cognitive impairment poststroke. This is an update of a Cochrane Review published in 2010.To assess the impact of occupational therapy on activities of daily living (ADL), both basic and instrumental, global cognitive function, and specific cognitive abilities in people who have cognitive impairment following a stroke.We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, four other databases (all last searched September 2020), trial registries, and reference lists.We included randomised and quasi-randomised controlled trials that evaluated an intervention for adults with clinically defined stroke and confirmed cognitive impairment. The intervention needed either to be provided by an occupational therapist or considered within the scope of occupational therapy practice as defined in the review. We excluded studies focusing on apraxia or perceptual impairments or virtual reality interventions as these are covered by other Cochrane Reviews. The primary outcome was basic activities of daily living (BADL) such as dressing, feeding, and bathing. Secondary outcomes were instrumental ADL (IADL) (e.g. shopping and meal preparation), community integration and participation, global cognitive function and specific cognitive abilities (including attention, memory, executive function, or a combination of these), and subdomains of these abilities. We included both observed and self-reported outcome measures.Two review authors independently selected studies that met the inclusion criteria, extracted data, and assessed the certainty of the evidence. A third review author moderated disagreements if consensus was not reached. We contacted trial authors for additional information and data, where available. We assessed the certainty of key outcomes using GRADE. MAIN RESULTS: We included 24 trials from 11 countries involving 1142 (analysed) participants (two weeks to eight years since stroke onset). This update includes 23 new trials in addition to the one study included in the previous version. Most were parallel randomised controlled trials except for one cross-over trial and one with a two-by-two factorial design. Most studies had sample sizes under 50 participants. Twenty studies involved a remediation approach to cognitive rehabilitation, particularly using computer-based interventions. The other four involved a compensatory and adaptive approach. The length of interventions ranged from 10 days to 18 weeks, with a mean total length of 19 hours. Control groups mostly received usual rehabilitation or occupational therapy care, with a few receiving an attention control that was comparable to usual care; two had no intervention (i.e. a waiting list). Apart from high risk of performance bias for all but one of the studies, the risk of bias for other aspects was mostly low or unclear. For the primary outcome of BADL, meta-analysis found a small effect on completion of the intervention with a mean difference (MD) of 2.26 on the Functional Independence Measure (FIM) (95% confidence interval (CI) 0.17 to 4.22; P = 0.03, I2 = 0%; 6 studies, 336 participants; low-certainty evidence). Therefore, on average, BADL improved by 2.26 points on the FIM that ranges from 18 (total assist) to 126 (complete independence). On follow-up, there was insufficient evidence of an effect at three months (MD 10.00, 95% CI -0.54 to 20.55; P = 0.06, I2 = 53%; 2 studies, 73 participants; low-certainty evidence), but evidence of an effect at six months (MD 11.38, 95% CI 1.62 to 21.14, I2 = 12%; 2 studies, 73 participants; low-certainty evidence). These differences are below 22 points which is the established minimal clinically important difference (MCID) for the FIM for people with stroke. For IADL, the evidence is very uncertain about an effect (standardised mean difference (SMD) 0.94, 95% CI 0.41 to 1.47; P = 0.0005, I2 = 98%; 2 studies, 88 participants). For community integration, we found insufficient evidence of an effect (SMD 0.09, 95% CI -0.35 to 0.54; P = 0.68, I2 = 0%; 2 studies, 78 participants). There was an improvement of clinical importance in global cognitive functional performance after the intervention (SMD 0.35, 95% CI 0.16 to 0.54; P = 0.0004, I2 = 0%; 9 studies, 432 participants; low-certainty evidence), equating to 1.63 points on the Montreal Cognitive Assessment (MoCA) (95% CI 0.75 to 2.52), which exceeds the anchor-based MCID of the MoCA for stroke rehabilitation patients of 1.22. We found some effect for attention overall (SMD -0.31, 95% CI -0.47 to -0.15; P = 0.0002, I2 = 20%; 13 studies, 620 participants; low-certainty evidence), equating to a difference of 17.31 seconds (95% CI 8.38 to 26.24), and for executive functional performance overall (SMD 0.49, 95% CI 0.31 to 0.66; P < 0.00001, I2 = 74%; 11 studies, 550 participants; very low-certainty evidence), equating to 1.41 points on the Frontal Assessment Battery (range: 0-18). Of the cognitive subdomains, we found evidence of effect of possible clinical importance, immediately after intervention, for sustained visual attention (moderate certainty) equating to 15.63 seconds, for working memory (low certainty) equating to 59.9 seconds, and thinking flexibly (low certainty), compared to control.The effectiveness of occupational therapy for cognitive impairment poststroke remains unclear. Occupational therapy may result in little to no clinical difference in BADL immediately after intervention and at three and six months' follow-up. Occupational therapy may slightly improve global cognitive performance of a clinically important difference immediately after intervention, likely improves sustained visual attention slightly, and may slightly increase working memory and flexible thinking after intervention. There is evidence of low or very low certainty or insufficient evidence for effect on other cognitive domains, IADL, and community integration and participation. Given the low certainty of much of the evidence in our review, more research is needed to support or refute the effectiveness of occupational therapy for cognitive impairment after stroke. Future trials need improved methodology to address issues including risk of bias and to better report the outcome measures and interventions used." @default.
- W4225607566 created "2022-05-05" @default.
- W4225607566 creator A5018525499 @default.
- W4225607566 creator A5051430568 @default.
- W4225607566 creator A5055094088 @default.
- W4225607566 creator A5059857721 @default.
- W4225607566 creator A5082120402 @default.
- W4225607566 creator A5090700680 @default.
- W4225607566 date "2022-03-29" @default.
- W4225607566 modified "2023-10-16" @default.
- W4225607566 title "Occupational therapy for cognitive impairment in stroke patients" @default.
- W4225607566 cites W102521931 @default.
- W4225607566 cites W1030953983 @default.
- W4225607566 cites W1470144357 @default.
- W4225607566 cites W1489919334 @default.
- W4225607566 cites W1509249114 @default.
- W4225607566 cites W1552751836 @default.
- W4225607566 cites W1574793511 @default.
- W4225607566 cites W1603091009 @default.
- W4225607566 cites W1613222808 @default.
- W4225607566 cites W1618038909 @default.
- W4225607566 cites W1640232137 @default.
- W4225607566 cites W1643291669 @default.
- W4225607566 cites W16678368 @default.
- W4225607566 cites W1710352472 @default.
- W4225607566 cites W1825183013 @default.
- W4225607566 cites W1847168837 @default.
- W4225607566 cites W1866068290 @default.
- W4225607566 cites W1890860972 @default.
- W4225607566 cites W1915483530 @default.
- W4225607566 cites W1961548083 @default.
- W4225607566 cites W1964428160 @default.
- W4225607566 cites W1972265376 @default.
- W4225607566 cites W1972469252 @default.
- W4225607566 cites W1973333626 @default.
- W4225607566 cites W1974509475 @default.
- W4225607566 cites W1975352837 @default.
- W4225607566 cites W1977238326 @default.
- W4225607566 cites W1979474084 @default.
- W4225607566 cites W1980827933 @default.
- W4225607566 cites W1986768461 @default.
- W4225607566 cites W1988040785 @default.
- W4225607566 cites W1991195591 @default.
- W4225607566 cites W1992220050 @default.
- W4225607566 cites W1993884624 @default.
- W4225607566 cites W1994540758 @default.
- W4225607566 cites W1994761355 @default.
- W4225607566 cites W1997713973 @default.
- W4225607566 cites W1998929270 @default.
- W4225607566 cites W1999806458 @default.
- W4225607566 cites W2000399989 @default.
- W4225607566 cites W2001162386 @default.
- W4225607566 cites W2003725908 @default.
- W4225607566 cites W2006710534 @default.
- W4225607566 cites W2008854521 @default.
- W4225607566 cites W2011156586 @default.
- W4225607566 cites W2017658548 @default.
- W4225607566 cites W2019132850 @default.
- W4225607566 cites W2023333147 @default.
- W4225607566 cites W2024900319 @default.
- W4225607566 cites W2026726345 @default.
- W4225607566 cites W2028836572 @default.
- W4225607566 cites W2029277950 @default.
- W4225607566 cites W2031696070 @default.
- W4225607566 cites W2033744418 @default.
- W4225607566 cites W2035491401 @default.
- W4225607566 cites W2035740399 @default.
- W4225607566 cites W2036020807 @default.
- W4225607566 cites W2037407063 @default.
- W4225607566 cites W2038837365 @default.
- W4225607566 cites W2041672075 @default.
- W4225607566 cites W2042223617 @default.
- W4225607566 cites W2042550081 @default.
- W4225607566 cites W2044500578 @default.
- W4225607566 cites W2046091703 @default.
- W4225607566 cites W2047825905 @default.
- W4225607566 cites W2049435933 @default.
- W4225607566 cites W2049937487 @default.
- W4225607566 cites W2051614539 @default.
- W4225607566 cites W2055001467 @default.
- W4225607566 cites W2058161128 @default.
- W4225607566 cites W2059496122 @default.
- W4225607566 cites W2065287647 @default.
- W4225607566 cites W2066142750 @default.
- W4225607566 cites W2066644560 @default.
- W4225607566 cites W2072743331 @default.
- W4225607566 cites W2072771781 @default.
- W4225607566 cites W2072986682 @default.
- W4225607566 cites W2075652726 @default.
- W4225607566 cites W2075658672 @default.
- W4225607566 cites W2076171862 @default.
- W4225607566 cites W2079986292 @default.
- W4225607566 cites W2080177505 @default.
- W4225607566 cites W2080340510 @default.
- W4225607566 cites W2080732726 @default.
- W4225607566 cites W2081922673 @default.
- W4225607566 cites W2082348827 @default.
- W4225607566 cites W2083208896 @default.
- W4225607566 cites W2084964166 @default.
- W4225607566 cites W2088828593 @default.