Effectiveness of active occupational therapy in patients with acute stroke: A propensity score-weighted retrospective study.
Shiori Yamakawa, Hirofumi Nagayama, Kounosuke Tomori and 2 others
PMID 36684684WHAT IT FOUND
In acute stroke, occupational therapy time exceeding physical therapy time was linked with better function and shorter stay, but speech therapy time also differed, so separate contributions are unclear.
Discharge home was not different. Severe daily function limits, aphasia, gaze or neglect appeared more responsive.
Key findings
01The active occupational therapy group had significantly greater improvement in the FIM daily function score and the NIHSS stroke severity score, and a significantly shorter length of hospital stay (p < 0.001).
02The rate of discharge to home did not differ significantly between groups (p = 0.201).
03In subgroup analysis, more severe ADL limitation and worse aphasia, gaze, or neglect were associated with higher FIM score increases in the active occupational therapy group (p = 0.001-0.040).
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
This was not a randomised trial, so patients who received more occupational therapy may have differed in ways the researchers did not measure. The groups were very different at baseline, and total FIM score on admission remained imbalanced after weighting. Patients received different amounts of physical therapy, occupational therapy, and speech and language therapy, so the study cannot separate the contribution of any single component. Missing data were imputed, and total FIM score on admission was missing for 18.0% of patients. The reported differences in outcome scores were small (4.5 points for FIM gain and 0.8 points for NIHSS gain).
The easy way to misread this
Do not read the better FIM and shorter stay as proof that more occupational therapy alone works or that it gets patients home. The study was observational, other therapy times differed, and discharge home was not significantly different.