Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on interventions to improve activities of daily living (ADL) and functional mobility performance for people with stroke. This theme reports on task-oriented training interventions.
Full Systematic Review Question
This systematic review addressed the question “What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve performance and participation in activities of daily living (ADL) for adult stroke survivors?”
Current Theme(s) Reported
The main theme of the studies included in this systematic review brief is task-oriented training (TOT) interventions (i.e., constraint-induced movement therapy [CIMT], task-oriented repetitive or circuit training, sit to stand, and hand/grasp).
Clinical Scenario
Stroke is the leading cause of adult disability in the United States with more than 7 million stroke survivors (Tsao et al., 2022). Many stroke survivors have great difficulties participating in activities of daily living (ADL; Gadidi et al., 2011), which is correlated with decreased life satisfaction (Hartman-Maeir et al., 2007). The occupational therapy (OT) task-oriented approach (TOA), which is composed of motor control, motor learning, and motor development theories, is a function-based approach for people with stroke (Mathiowetz & Bass-Haugen, 1994). A great deal of task-oriented training (TOT) research has identified TOT intervention to support improvements in upper extremity function and functional mobility, with fewer studies showing support for activity and participation improvements (Nilsen et al., 2015). The systematic review theme presented here addresses TOT in regard to CIMT, task-oriented repetitive or circuit training, and specific task training including sit to stand, and hand/grasp for improved ADL performance including basic ADL (BADL; i.e., Short Form 12 [Jakobsson et al., 2012] and Barthel Index [Hsueh et al., 2001]) and functional mobility (i.e., Timed Up and Go [Flansbjer et al., 2005] and Berg Balance Scale [Berg et al., 1995]).
Summary of Key Findings
Three Level 1A (meta-analyses) studies and three Level 1B (randomized control trials [RCT]) met the criteria for inclusion to examine the effectiveness of TOT for functional mobility and ADL. The risk of bias (RoB) for a majority of the studies was low, with two studies showing moderate RoB. The studies in this theme were subdivided into four areas: CIMT, task-oriented repetitive or circuit training, sit to stand, and hand/grasp (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009). The strength-of-evidence designations are based on the guidelines of the U.S. Preventive Services Task Force (2018).
Evidence table for task-oriented training interventions for adults with stroke
Note. ADL = activities of daily living; AROM = active range of motion; BADL = basic activities of daily living; CIMT = constraint-induced movement therapy; MAS = motor assessment scale; PROM = passive range of motion; RCT = randomized control trials; RoB = risk of bias; TOT = task-oriented training.
Bottom Line for Occupational Therapy Practice
The results of the included studies indicate that occupational therapy practitioners may possibly use task-oriented training for functional mobility, however not for basic BADL. However, it should be noted that of the three studies that measured functional mobility, only one study, in the task-oriented training subgroup, showed group differences for functional mobility (Askim et al., 2010), whereas the other two studies, in the CIMT and task-oriented training subsections, respectively, did not (Choi et al., 2017, Jeon et al., 2015). Furthermore, the four studies that examined BADL outcome measures did not examine the functional mobility measures of interest for this review (Barzel et al., 2015; Corbetta et al., 2015; Harris et al., 2009; Pollock et al., 2014); thus, further research is needed to examine functional mobility. Although a majority of the task-oriented training interventions showed low strength of evidence for functional mobility and BADL, some of these strategies have been shown to be beneficial for upper limb function. Studies have shown the benefits of CIMT in upper limb function poststroke (Corbetta et al., 2015; Kwakkel et al., 2015).
Footnotes
*
Indicates articles included in the brief systematic review.