JMIR Publications

ABSTRACT

Background:

Stroke is a leading cause of disability, commonly resulting in difficulty completing basic and instrumental activities of daily living. Rehabilitation is recommended to improve functional performance, however it remains unknown whether early (hospital-based) intervention is effective nor the intervention components that should be delivered.

Objective:

We propose a systematic review to summarize the evidence for the effectiveness of activity-based interventions, led by occupational therapists, for improving performance of basic activities of daily living (b-ADL) or simple cognitive instrumental activities of daily living (C-IADL) by adults with stroke. Reviewing simple C-IADLs as opposed to instrumental activities of daily living will allow us to review interventions for activities with similar executive functioning demands. By identifying effective interventions, we aim to improve outcomes for stroke survivors by maximizing independence during hospitalization.

Methods:

Searches will be conducted in MEDLINE, CINAHL, EMBASE and Cochrane Controlled Register of Trials. We will include randomized controlled trials and quasi-randomized controlled trials which include adult stroke survivors and which are testing interventions (delivered in the hospital setting) that aimed to improve or promote independence in b-ADL or C-IADL activities. Two reviewers will independently screen full text articles and one reviewer will extract data, with a second reviewer providing confirmation. The PEDro Scale will be used to assess methodological quality of studies. Cochran Q test will assess heterogeneity among studies, then where appropriate, meta-analysis will be performed. Measures of outcome may include global rating of function (such as the Functional Independence Measure, FIM™) or specific task performance assessments (such as the Nottingham Dressing Assessment).

Results:

Results will be presented based on subgroup analyses where able, including activity type (activity or occupation level), time post-stroke (within or greater than 1 week), and delivery of intervention (group or individualized).

Conclusions:

This systematic review will address the current gap in the literature regarding activity-based interventions for stroke survivors, within the inpatient setting, and provide clinical guidance on the most effective methods, if any, for improving independence early after stroke. Clinical Trial: PROSPERO, https://www.crd.york.ac.uk/prospero/ (Registration ID: CRD42024562195)