Hildebrand Mary W, Geller Daniel, Proffitt Rachel
Mary W. Hildebrand, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA.
Daniel Geller, EdD, MPH, OTR/L, is Assistant Professor of Rehabilitation and Regenerative Medicine, Programs in Occupational Therapy, Columbia University, New York, NY.
Am J Occup Ther. 2023 Sep 1;77(5). doi: 10.5014/ajot.2023.077501.
Stroke is a leading cause of disability. Occupational therapy practitioners ensure maximum participation and performance in valued occupations for stroke survivors and their caregivers.
These Practice Guidelines are meant to support occupational therapy practitioners' clinical decision making when working with people after stroke and their caregivers.
Clinical recommendations were reviewed from three systematic review questions on interventions to improve performance and participation in daily activities and occupations and from one question on maintaining the caregiving role for caregivers of people after stroke.
The systematic reviews included 168 studies, 24 Level 1a, 90 Level 1b, and 54 Level 2b. These studies were used as the basis for the clinical recommendations in these Practice Guidelines and have strong or moderate supporting evidence.
Interventions with strong strength of evidence for improving performance in activities of daily living and functional mobility include mirror therapy, task-oriented training, mental imagery, balance training, self-management strategies, and a multidisciplinary three-stages-of-care rehabilitation program. Constraint-induced therapy has strong strength of evidence for improving performance of instrumental activities of daily living. Moderate strength of evidence supported cognitive-behavioral therapy (CBT) to address balance self-efficacy, long-term group intervention to improve mobility in the community, and a wearable upper extremity sensory device paired with training games in inpatient rehabilitation to improve social participation. Practitioners should incorporate problem-solving therapy in combination with CBT or with education and a family support organizer program. What This Article Adds: These Practice Guidelines provide a summary of strong and moderate evidence for effective interventions for people with stroke and for their caregivers.
中风是导致残疾的主要原因。职业治疗从业者确保中风幸存者及其照顾者能够最大程度地参与并胜任有价值的活动。
这些实践指南旨在支持职业治疗从业者在为中风患者及其照顾者提供服务时进行临床决策。
对关于改善日常活动和职业表现及参与度的干预措施的三个系统评价问题，以及关于维持中风患者照顾者照顾角色的一个问题进行了临床建议审查。
系统评价纳入了168项研究，其中24项为1a级，90项为1b级，54项为2b级。这些研究被用作本实践指南中临床建议的依据，并有强有力或中等程度的支持证据。
有强有力证据支持的改善日常生活活动能力和功能移动性的干预措施包括镜像疗法、任务导向训练、心理意象、平衡训练、自我管理策略以及多学科三阶段护理康复计划。强制性使用疗法有强有力的证据支持可改善日常生活工具性活动能力。中等程度的证据支持认知行为疗法（CBT）以解决平衡自我效能感问题、长期团体干预以改善社区中的移动性，以及在住院康复中使用可穿戴上肢感觉设备并结合训练游戏以提高社会参与度。从业者应将解决问题疗法与CBT或与教育及家庭支持组织计划相结合。本文补充内容：这些实践指南总结了针对中风患者及其照顾者的有效干预措施的强有力和中等程度的证据。
