Occupational therapy for stroke patients not admitted to hospital: a randomised controlled trial

Background Patients who have a stroke are not always admitted to hospital, and 22-60% remain in the community, frequently without coordinated rehabili tation. We aimed to assess the efficacy of an occupational therapy interven tion for patients with stroke who were not admitted to hospital. Methods In this single-blind randomised controlled trial, consecutive strok e patients on a UK community register in Nottingham and Derbyshire were all ocated 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 occ upational therapy was to encourage independence in personal and instrumenta l activities of daily living. Patients were assessed on outcome measures at baseline (before randomisation) and at 6 months. The primary outcome measu re was the score on the extended activities of daily living (EADL) scale at 6 months. Other outcome measures included the Barthel index, the general h ealth questionnaire 28, the carer strain index, and the London handicap sca le. All assessments were done by an independent assessor who was unaware of treatment allocation. The analysis included only data from completed quest ionnaires. Findings 185 patients were included: 94 in the occupational therapy group a nd 91 in the control group. 22 patients were not assessed at 6 months. At f ollow-up, patients who had occupational therapy had significantly higher me dian scores than the controls on: the EADL scale (16 vs 12, p<0.01, estimat ed difference 3 [95% CI 1 to 41); the Barthel index (20 vs 18, p<0.01, diff erence 1, [0-1]); the carer strain index (1 vs 3, p<0.05, difference 1[0 to 2]); and the London handicap scale (76 vs 65, p<0.05, difference 7, [0 3 t o 13.5]). There were no significant differences on the general health quest ionnaire between the patient or carer. Interpretation Occupational therapy significantly reduced disability and ha ndicap in patients with stroke who were not admitted to hospital.