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Occupational therapy for stroke patients not addmitted to hospital: a randomised controlled trial
Walker MF, Gladman JRF, Lincoln NB, Siemonsma P, Whitlely T
Lancet 1999 Jul 24;354(9175):278-280
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Patients who have a stroke are not always admitted to hospital, and 22 to 60% remain in the community, frequently without coordinated rehabilitation. We aimed to assess the efficacy of an occupational therapy intervention for patients with stroke who were not admitted to hospital. METHODS: In this single-blind randomised controlled trial, consecutive stroke patients on a UK community register in Nottingham and Derbyshire were allocated randomly to up to 5 months of occupational therapy at home or to no intervention (control group) 1 month after their stroke. The aim of the occupational therapy was to encourage independence in personal and instrumental activities of daily living. Patients were assessed on outcome measures at baseline (before randomisation) and at 6 months. The primary outcome measure was the score on the extended activities of daily living (EADL) scale at 6 months. Other outcome measures included the Barthel Index, the general health questionnaire 28, the carer strain index, and the London handicap scale. All assessments were done by an independent assessor who was unaware of treatment allocation. The analysis included only data from completed questionnaires. FINDINGS: 185 patients were included: 94 in the occupational therapy group and 91 in the control group. 22 patients were not assessed at 6 months. At follow-up, patients who had occupational therapy had significantly higher median scores than the controls on: the EADL scale (16 versus 12, p < 0.01, estimated difference 3 (95% C1 1 to 4)); the index (20 versus 18, p < 0.01, difference 1 (0 to 1)); the carer strain index (1 versus 3, p < 0.05, difference 1 (0 to 2)); and the London handicap scale (76 versus 65, p < 0.05, difference 7 (0.3 to 13.5)). There were no significant differences on the general health questionnaire between the patient or carer. INTERPRETATION: Occupational therapy significantly reduced disability and handicap in patients with stroke who were not admitted to hospital.

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