Five-year follow-up of a cluster-randomized controlled trial of a client-centred activities of daily living intervention for people with stroke.
Annicka Hedman, Gunilla Eriksson, Lena von Koch and 1 others
PMID 30409049WHAT IT FOUND
Five years after stroke, a client-centred daily living intervention did not improve participants' perceived participation compared with usual daily living care.
Their significant others had fewer depression signs, but this was not the main result.
Key findings
01At five years, there were no differences between the client-centred intervention group and the usual intervention group in the primary outcome, perceived participation.
02For people with stroke, no other group differences were found in the secondary outcomes at five years.
03Significant others of people with stroke who received the client-centred intervention had lower depression scores and fewer signs of depression at five years.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study was underpowered for a five-year comparison of perceived participation. Only people who contributed data at five years were included in the analyses. More vulnerable people with stroke tended to drop out. Non-participants were older, less active before stroke onset, more often had moderate or severe stroke, and more often lived alone. No baseline Hospital Anxiety and Depression Scale data were available for significant others. The usual activities of daily living interventions might have included client-centred elements, so the two approaches may have been too similar. New strokes and other major life events were not controlled for.
The easy way to misread this
Do not read the lower depression scores in significant others as proof that the client-centred ADL intervention works. The primary outcome for people with stroke was null, the study was underpowered for five-year comparisons, and no baseline mood data were available for significant others.