Effectiveness of Occupational Therapy Interventions to Improve Performance and Participation in Instrumental Activities of Daily Living (IADL) Among Adult Stroke Survivors (2009–2019)

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 instrumental activities of daily living (IADL) among adult stroke survivors?”

Current Themes Reported

The main themes of the studies included in this systematic review brief are virtual reality, exercise, vision rehabilitation, and community-based stroke empowerment group.

Clinical Scenario

Deficits related to stroke can limit engagement in valued occupations and may cause a reduction in stroke survivors’ ability to participate in daily occupations (Nilsen et al., 2012). There are a variety of interventions within the scope of occupational therapy that can be implemented with stroke survivors, to improve their performance during daily occupations and instrumental activities of daily living (IADLs). Virtual reality has emerged as an innovative intervention approach for treatment in stroke rehabilitation (Laver et al., 2015). Easily accessible and affordable commercial gaming consoles have led to increased use of virtual reality by occupational therapy practitioners in the clinical setting (Standen et al., 2017). Implementation of virtual reality has been increasingly used in a variety of therapy settings, due to the intensive repetitive practice that can be performed within the interactive gaming systems, and the easy access to these systems in the commercial market. Additional interventions to address IADLs include exercise programs, vision rehabilitation, and community-based stroke empowerment groups. These interventions fall within occupational therapy’s scope of practice and have been investigated for their effectiveness in improving functional performance in daily occupations following a stroke. This systematic review brief discusses findings in the literature related to the effectiveness of these interventions for improving IADL performance in adult stroke survivors.

Summary of Key Findings

Three Level 1B studies and two Level 2B studies that used interventions to improve IADL performance in adult stroke survivors met the criteria for inclusion in this systematic review. The risk of bias for most of the studies was low, with one study having moderate risk of bias. The studies in this theme involved virtual reality, exercise, vision rehabilitation, and community-based stroke empowerment groups (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).

Bottom Line for Occupational Therapy Practice

Initial results indicate that community-based stroke empowerment groups should be used by occupational therapy practitioners to enhance self-management knowledge and skills for adult stroke survivors. Empowerment groups run by skilled clinicians may provide stroke survivors with knowledge and skills to enhance self-management. These empowerment groups lead to improved performance during functional tasks, as adult stroke survivors demonstrated significant improvements on IADL scores at all postintervention time points (Sit et al., 2016). Participating in stroke empowerment groups with other stroke survivors provided opportunities for problem-solving between peers, which had a positive effect on functional performance of daily occupations (IADLs).

Virtual reality continues to emerge as an intervention tool utilized by occupational therapy practitioners for treating deficits related to stroke. While virtual reality is used in various rehabilitation settings, there is low strength of evidence related to its effectiveness in improving functional performance of IADL tasks in the stroke population. More research related to the effect of virtual reality on IADL performance is needed, as there were no statistically significant changes between groups or within groups in the study included in this review (Standen et al., 2017).

Aerobic training and exercise are used throughout various rehabilitation settings for improving functional recovery and activity level among stroke survivors (Wang et al., 2016). Current literature provides inconsistent results in utilizing aerobic exercise for improving functional performance of daily occupations. A study using low intensity ergometer aerobic training demonstrated significant improvement on outcome measures looking at heavy housework, and travel outings, but a community-based exercise group did not demonstrate statistically significant results for IADL performance. These results suggest that individual aerobic training may be used in occupational therapy practice for improving IADL performance in stroke.

Visual rehabilitation that is commonly used in occupational therapy practice consists of visual search compensatory training and provision of prisms (Sit et al., 2016). While both treatments are widely used throughout the rehabilitation of stroke survivors with hemianopia, there is limited evidence to support the effectiveness of either treatment for improving IADL performance. Strategy training, such as visual search compensatory training, may still be beneficial for improving safety awareness during functional mobility or task performance.

Overall, there is low strength of evidence to support the use of virtual reality, vision rehabilitation, and aerobic exercise for improving IADL performance in adult stroke survivors. There is moderate strength of evidence to support the use of community-based stroke groups led by occupational therapy practitioners or other rehabilitation specialists for targeting functional performance of IADLs. There is limited research to support the effectiveness of these interventions for improving IADLs in the adult stroke population. Additional research is needed for the effectiveness of various interventions for specifically targeting IADLs in adult stroke survivors.