The Cochrane review of occupational therapy for cognitive impairment in stroke patients

Cognitive impairment frequently follows stroke and impairs everyday activities. This review aimed to determine whether occupational therapy improves functional performance of basic activities of daily living (ADL) and specific cognitive abilities in people who have cognitive impairment after stroke. In this review, randomised and quasi-randomised controlled trials that evaluated an occupational therapy intervention focused on providing cognitive retraining to adults with clinically defined stroke and confirmed cognitive impairment were included. Searches up to April 2009 were conducted in: the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, PsycBITE, OTseeker, and Dissertation Abstracts. The search also included a review of the reference lists of relevant studies, a hand-search of relevant occupational therapy journals, and contact with key researchers in the area. Two review authors independently examined the abstracts that might meet the inclusion criteria, assessed the methodological quality, and extracted data. Of 17 trials that appeared to be relevant and were reviewed in full text, only one trial (N=33) was finally included in this review. The study was an RCT of cognitive skills remediation training and there was no difference between groups for the two outcomes that were relevant to this review that were measured: improvement in time judgement skills and improvement in basic ADLs on the Barthel Index. The effectiveness of occupational therapy for cognitive impairment post-stroke remains unclear. The potential benefits of cognitive retraining delivered as part of occupational therapy on improving basic daily activity function or specific cognitive abilities, or both, of people who have had a stroke cannot be supported or refuted by the evidence included in this review. More research is required.