No abstract

Background and Purpose-Trials of occupational therapy for stroke patients living in the community have varied in their findings. It is unclear why these discrepancies have occurred. Methods-Trials

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Objective To establish if a brief programme of domiciliary occupational therapy could improve the recovery of patients with stroke discharged from hospital. Design Single blind randomised controlled trial. Setting Two hospital sites within a UK teaching hospital.

Consecutive admissions to an urban teaching hospital (Glasgow Royal Infirmary) over an 18-month period who fulfilled the World Health Organisation' s (1973) clinical diagnosis of stroke were identified. Patients with subarachnoid haemorrhage were excluded because this younger patient group was usually managed in a different hospital. Ethical approval for the study was provided by the local ethics committee. Recruitment and randomisation Patients were eligible for the trial if they had been referred to occupational therapy and planned to return home at discharge from hospital. Patients who were unable to take part in the trial (that is, those with severe cognitive or communication problems, living outside the hospital area or who refused consent) or for whom the service might be inappropriate (that is, those with a full recovery after stroke, a discharge to institutional care or a terminal illness) were This study evaluated a short post-discharge home-based occupational therapy service for stroke patients, including an assessment of the patients' satisfaction with occupational performance and service provision. A single-site, blind randomised controlled trial was conducted. One hundred and thirty-eight patients were randomly allocated to either a conventional outpatient follow-up or conventional services plus 6 weeks of home-based occupational therapy. The data were collected before discharge and at 7 weeks and 6 months after discharge using the Canadian Occupational Performance Measure (COPM), the Dartmouth COOP Charts, the London Handicap Scale and a patient satisfaction questionnaire. At 7 weeks the intervention group reported significantly greater changes in performance and satisfaction on the COPM, better emotional scores (Dartmouth COOP Charts) and improved work and leisure activity scores (London Handicap Scale). No other differences in subjective health status were described. By 6 months, the intervention group was more satisfied with several aspects of service provision but no other differences in subjective health experience were reported. A 6-week post-discharge home-based occupational therapy service can improve patients' perceptions of their occupational performance and satisfaction with services but may not have a long-term effect on subjective health outcomes.