Department of Experimental and Clinical Medicine, University of Florence, Italy; Fondazione don Carlo Gnocchi, Scientific Institute, Florence, Italy.
NeuroRehabilitation. 2023;53(1):167-171. doi: 10.3233/NRE-236002.
Cognitive Impairment (CI) after stroke is frequent and often persistent, and is associated with poor functional outcome. Occupational therapy (OT) is aimed at restoring functioning also by addressing CI.
Commentary on the review by Gibson et al. (2022) updating a previous Cochrane Review (Hoffmann et al., 2010) to investigate the effectiveness of OT on CI after stroke.
This review included randomised and quasi-randomised controlled trials evaluating OT for adults with clinically defined stroke and confirmed CI. Outcomes included basic activities of daily living (BADL) (primary), instrumental ADL (IADL), community integration and participation, global cognitive function and specific cognitive abilities.
Overall, 24 trials from 11 countries including 1142 participants. For BADL, a small effect below the minimal clinically important difference (MCID) was found immediately after intervention and at six months' follow-up (low certainty evidence), but not at three months follow-up (insufficient evidence). For IADL, the evidence was very uncertain about an effect, while for community integration, there was insufficient evidence of an effect. For global cognitive performance, there was an improvement of clinical importance after the intervention (low-certainty). There was some effect for attention overall, and for executive functional performance overall (very low-certainty). Of the cognitive subdomains, there was evidence of effect of possible clinical importance, immediately after intervention, only for sustained visual attention (moderate certainty), for working memory (low certainty), and thinking flexibly (low certainty), while there was only low or very low certainty or insufficient evidence of an effect for other cognitive domains/subdomains;CONCLUSION:The authors concluded that the body of evidence for the effectiveness of OT interventions has improved since their first review. However, although their findings provide some support for the potential benefits of OT (mostly based on low certainty evidence), OT effectiveness for stroke patients remains unclear.
脑卒中后认知障碍（CI）较为常见且常持续存在，并与不良功能结局相关。作业治疗（OT）旨在通过治疗 CI 来恢复功能。
对 Gibson 等人（2022 年）的综述进行述评，该综述更新了 Cochrane 综述（Hoffmann 等人，2010 年），以调查脑卒中后 OT 对 CI 的疗效。
本综述纳入了评估针对成人脑卒中后伴有明确 CI 的患者的 OT 治疗的随机和准随机对照试验。结局包括基本日常生活活动（BADL）（主要结局）、工具性日常生活活动（IADL）、社区融入和参与、整体认知功能和特定认知能力。
共有来自 11 个国家的 24 项试验，纳入了 1142 名参与者。干预后即刻和 6 个月随访时，BADL 有较小但低于临床最小重要差异（MCID）的效应（低质量证据），但在 3 个月随访时无效应（证据质量不足）。IADL 的效应证据不确定，而社区融入的效应证据不足。整体认知表现的干预后改善有临床意义（低质量证据）。注意力和执行功能表现的总体效应有改善（极低质量证据）。在认知亚领域中，干预后即刻注意力和工作记忆的效应有临床重要性的证据（中等质量），思维灵活性的效应有临床重要性的证据（低质量），而其他认知领域/亚领域的效应证据质量低或极低，或证据不足。
作者得出结论，自首次综述以来，OT 干预有效性的证据质量有所提高。然而，尽管他们的发现为 OT 的潜在益处提供了一些支持（主要基于低质量证据），但 OT 对脑卒中患者的疗效仍不明确。
