Document Type

Critically Appraised Topic

Publication Date

2011

Clinical Scenario

Individuals with stroke who received multidisciplinary services are more likely to live independently at home one year after stroke (Stroke Unit Trialists’ Collaboration, 2007). However, following discharge, individuals with stroke often feel isolated and have decreased engagement in activities they previous enjoyed. (Rittman, Boylstein, Hinojosa, Hinojosa, & Haun, 2007). In addition, community reintegration remains a challenge for individuals with stroke due to decreased self-efficacy and opportunities to regain self confidence (Wood, Connelly, & Maly, 2010).

In 2006, Latham et al. conducted a descriptive study to summarize the current clinical practice of occupational therapy interventions in six inpatient stroke rehabilitation hospitals. About 40% of the occupational therapy services provided focus on life skills such as activities of daily livings (ADLs) and some instrumental activities of daily living (IADLs). Only about 12% of the services focus on leisure, home management, or community integration. Preparatory activities were used in more than half of the therapy time establishing or restoring body function and structure, or motor skills such as upper extremity control, passive range of motion, postural awareness, sitting balance, etc.

Other non-traditional interventions such as early supported discharge, use of outdoor powered wheelchairs, family-centered leisure education, driving rehabilitation, and attainment of social support had been shown to promote community reintegration for individuals with stroke. Such results suggest that occupational therapy services should increase focus on other important areas of occupation to promote community reintegration for individuals with stroke.

Clinical Question

What non-traditional occupational therapy interventions promote community reintegration for individuals with stroke?

Clinical Bottom Line

Other non-traditional interventions: early supported discharge, use of outdoor powered wheelchairs, family-centered leisure education, driving rehabilitation, and attainment of social support, are effective in promoting community reintegration for individuals with stroke. OT services should increase focus in important areas of occupation other than ADLs.

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