Therapy-based rehabilitation services for patients living at home more than one year after stroke.

BACKGROUND: Current practice of rehabilitation intervention mainly concentrates on the first six months of stroke. At present, there is no agreed consensus about the benefits of such a service more than one year after stroke. OBJECTIVES: To ascertain whether therapy-based rehabilitation services can influence outcome one year or more after stroke. SEARCH STRATEGY: We searched the trials registers of the following Cochrane Review Groups: Stroke Group (last searched September 2007), Effective Practice and Organisation of Care Group (last searched October 2006) and Dementia and Cognitive Improvement Group (last searched October 2006). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2006), MEDLINE (1966 to October 2006), EMBASE (1980 to October 2006), CINAHL (1982 to October 2006), AMED (1985 to October 2006), PEDro (1952 to October 2006), British Nursing Index (1993 to October 2006), DARE (1994 to October 2006), HMIC (1979 to October 2006) and NHS EED (1991 to October 2006). We also searched dissertation databases and ongoing trials and research registers, scanned reference lists and contacted researchers and experts in the field. SELECTION CRITERIA: All randomised controlled trials of community-based stroke patients, in which at least 75% were recruited one year after stroke and received a therapy-based rehabilitation intervention that was compared with conventional care. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials and extracted data on a number of pre-specified outcomes. The primary outcomes were the proportion of participants who had deteriorated or were dependent in personal activities of daily living at the end of scheduled follow up. MAIN RESULTS: We identified five trials of 487 participants that were eligible for the review. Overall, there was inconclusive evidence as to whether therapy-based rehabilitation intervention one year after stroke was able to influence any relevant patient or carer outcome. Trials varied in design, type of interventions provided, quality, and outcomes assessed. AUTHORS' CONCLUSIONS: This review highlights the dearth of evidence investigating long-term therapy-based rehabilitation interventions for patients with stroke.

Occupational therapy for patients with problems in activities of daily living after stroke.

BACKGROUND: Occupational therapy aims to help people reach their maximum level of function and independence in all aspects of daily life. OBJECTIVES: To determine whether occupational therapy focused specifically on personal activities of daily living improves recovery for patients following stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched January 2006). In addition, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006), CINAHL (1983 to March 2006), PsycLIT (1974 to March 2006), AMED (1985 to March 2006), Wilson Social Sciences Abstracts (1984 to March 2006) and the following Web of Science databases: Science Citation Index (1945 to March 2006), Social Science Citation Index (1956 to March 2006) and Arts and Humanities Citation Index (1975 to March 2006). In an effort to identify further published, unpublished and ongoing trials we searched The Occupational Therapy Research Index and Dissertation Abstracts register, scanned reference lists of relevant articles, contacted authors and researchers and handsearched relevant journals. SELECTION CRITERIA: We identified randomised controlled trials of an occupational therapy intervention (compared to usual care or no care) where stroke patients practiced personal activities of daily living, or performance in activities of daily living was the focus of the occupational therapy intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials and extracted data for pre-specified outcomes. The primary outcomes were the proportion of patients who had deteriorated or were dependent in personal activities of daily living and performance in personal activities of daily living at the end of follow up. MAIN RESULTS: We identified 64 potentially eligible trials and included 10 studies (1348 participants). Occupational therapy interventions reduced the odds of a poor outcome (Peto odds ratio 0.67 (95% confidence interval (CI) 0.51 to 0.87; P = 0.003). and increased personal activity of daily living scores (standardised mean difference 0.18 (95% CI 0.04 to 0.32; P = 0.01). For every 11 (95% CI 7 to 30) patients receiving an occupational therapy intervention to facilitate personal activities of daily living, one patient was spared a poor outcome. AUTHORS' CONCLUSIONS: Patients who receive occupational therapy interventions are less likely to deteriorate and are more likely to be independent in their ability to perform personal activities of daily living. However, the exact nature of the occupational therapy intervention to achieve maximum benefit needs to be defined.

Rehabilitation therapy services for stroke patients living at home: systematic review of randomised trials.

BACKGROUND: Stroke-unit care can be valuable for stroke patients in hospital, but effectiveness of outpatient care is less certain. We aimed to assess the effects of therapy-based rehabilitation services targeted at stroke patients resident in the community within 1 year of stroke onset or discharge from hospital. METHODS: We did a systematic review of randomised trials of outpatient services, including physiotherapy, occupational therapy, and multidisciplinary teams. We used Cochrane collaboration methodology. FINDINGS: We identified a heterogeneous group of 14 trials (1617 patients). Therapy-based rehabilitation services for stroke patients living at home reduced the odds of deteriorating in personal activities of daily living (odds ratio 0.72 [95% CI 0.57-0.92], p=0.009) and increased ability of patients to do personal activities of daily living (standardised mean difference 0.14 [95% CI 0.02-0.25], p=0.02). For every 100 stroke patients resident in the community receiving therapy-based rehabilitation services, seven (95% CI 2-11) would not deteriorate. INTERPRETATION: Therapy-based rehabilitation services targeted at selected patients resident in the community after stroke improve ability to undertake personal activities of daily living and reduce risk of deterioration in ability. These findings should be considered in future service planning.

Quality control of the automatic processor.

An often ignored component of a radiology quality control program is daily sensitometric testing of automatic film processors. Sensitometric strip tests can reveal fluctuating chemical activity levels of developing solutions that can have a detrimental effect on developing films. By performing a daily sensitometric strip test before patient films are developed, time, cost, and patient radiation exposure are minimized, which reduces the number of retakes as a result of processing problems. Sensitometric strip tests also assist in quality control by making troubleshooting more specific.

Barriers to achieving evidence-based stroke rehabilitation.

OBJECTIVE: To determine the perceived barriers to evidence-based practice by health professionals working within the field of stroke rehabilitation. DESIGN: Focus groups were carried out to identify the perceived barriers; these were followed by a postal questionnaire that asked stroke rehabilitation professionals to rate their agreement with the perceived barriers. SUBJECTS: One hundred and five stroke rehabilitation professionals participated in the focus groups and were sent the postal questionnaire. Eighty-six responses were returned, from 27 physiotherapists, 26 occupational therapists, 22 nurses, 6 speech and language therapists, and 5 other professionals. MAIN OUTCOME MEASURES: Proportion of subjects rating their level of agreement with statements as 1 'agree', 2, 3, 4 or 5 'disagree'. Scores of 1 or 2 were classified as 'agreement', and scores of 4 or 5 were classified as 'disagreement': the percentages of subjects agreeing or disagreeing with each statement were calculated. RESULTS: Twenty barriers were identified, classified under the headings 'ability', 'opportunity' and 'implementation'. Seventy-nine (92%) of all respondents agreed that keeping up to date with research findings was important to them, but only 7 (8%) were happy with the time that they had to do this. Fifty-eight (67%) perceived a need for further training. Only 4 (5%) agreed that it was easy to transfer research findings into their daily practice. A number of significant differences were found between the perceived barriers of different disciplines.