Does occupational therapy improve activities of daily living and/or cognitive abilities in stroke patients with cognitive impairment? A Cochrane Review summary with commentary

BACKGROUND: Cognitive Impairment (CI) after stroke is frequent and often persistent, and is associated with poor functional outcome. Occupational therapy (OT) is aimed at restoring functioning also by addressing CI. OBJECTIVE: Commentary on the review by Gibson et al. (2022) updating a previous Cochrane Review (Hoffmann et al., 2010) to investigate the effectiveness of OT on CI after stroke. METHODS: This reviewincluded randomised and quasi-randomised controlled trials evaluatingOT for adults with clinically defined stroke and confirmed CI. Outcomes included basic activities of daily living (BADL) (primary), instrumental ADL (IADL), community integration and participation, global cognitive function and specific cognitive abilities. RESULTS: Overall, 24 trials from 11 countries including 1142 participants. For BADL, a small effect below the minimal clinically important difference (MCID) was found immediately after intervention and at six months' follow-up (low certainty evidence), but not at three months follow-up (insufficient evidence). For IADL, the evidence was very uncertain about an effect, while for community integration, there was insufficient evidence of an effect. For global cognitive performance, there was an improvement of clinical importance after the intervention (low-certainty). There was some effect for attention overall, and for executive functional performance overall (very low-certainty). Of the cognitive subdomains, there was evidence of effect of possible clinical importance, immediately after intervention, only for sustained visual attention (moderate certainty), for working memory (low certainty), and thinking flexibly (low certainty), while there was only low or very low certainty or insufficient evidence of an effect for other cognitive domains/subdomains. CONCLUSION: The authors concluded that the body of evidence for the effectiveness of OT interventions has improved since their first review. However, although their findings provide some support for the potential benefits of OT (mostly based on low certainty evidence), OT effectiveness for stroke patients remains unclear.