Systematic review of hospital-based interventions to improve post-stroke independence in activities of daily living.

INTRODUCTION: Early after stroke, inpatients commonly experience difficulty performing activities of daily living (ADL). Occupational therapists are key to providing early rehabilitation to optimise recovery. However, the effectiveness of early, activity-based retraining of ADLs is not clear. The aim of this systematic scoping review is to determine whether activity-based retraining targeting basic activities of daily living (b-ADL) and/or simple cognitive instrumental activities of daily living (C-IADL) delivered early after stroke improves functional independence. METHODS: MEDLINE, CINAHL, and Embase were searched. Eligible studies included randomised controlled trials or quasi-randomised trials, with at least 75% of participants over the age of 18, with a stroke diagnosis, and who received activity-based interventions within the hospital setting. Articles were screened by two authors using Covidence. Risk of bias was assessed using Cochrane's Risk of Bias tool (RoB2). All results were meta-analysed using Comprehensive Meta Analysis software (V4.0). CONSUMER AND COMMUNITY INVOLVEMENT: No consumer or community involvement was included in this study. RESULTS: A total of 7546 articles were screened, and six studies including n = 254 participants met the inclusion criteria. Performance outcome measure results were meta-analysed; there was no statistically significant impact of activity-based interventions on functional performance (standardised mean difference [SMD] = 0.41; 95% confidence interval [CI] -0.06, 0.87; P = 0.09). Two studies reviewed quality of life and satisfaction outcomes; data were not synthesised. CONCLUSION: Whereas individual trials suggested improvements early after activity-based training, our meta-analysis showed variability in effects in trials to date. Further research is required to determine the clinical and cost-effectiveness of activity-based interventions within the hospital setting to guide occupational therapy practice.