Non-pharmacological interventions for the improvement of post-stroke activities of daily living and disability amongst older stroke survivors: A systematic review.

Carrie Stewart,Pamela Paton,Alfonso J Cruz-Jentoft,Selvarani Subbarayan,Iosief Abraha,Elliot Gemmell,Denis O’Mahony,Roy L Soiza,Antonio Cherubini,Phyo Kyaw Myint,Antony Bayer

doi:10.1371/journal.pone.0204774

Abstract

Globally, stroke remains a leading cause of death and disability, with older adults disproportionately affected. Numerous non-pharmacological stroke rehabilitation approaches are in use to address impairments, but their efficacy in older persons is largely unknown. This systematic review examined the evidence for such interventions as part of the Optimal Evidence-Based Non-Drug Therapies in Older Persons (ONTOP) project conducted under an European Union funded project called the Software Engine for the Assessment and Optimisation of Drug and Non-Drug Therapies in Older Persons (SENATOR) [http://www.senator-project.eu]. A Delphi panel of European geriatric experts agreed activities of daily living and disability to be of critical importance as stroke rehabilitation outcomes. A comprehensive search strategy was developed and five databases (Pubmed, CINAHL, Embase, PsycInfo and Cochrane Database of Systematic Reviews) searched for eligible systematic reviews. Primary studies meeting our criteria (non-pharmacologic interventions, involving stroke survivors aged ≥65 years, assessing activities of daily living and/or disability as outcome) were then identified from these reviews. Eligible papers were double reviewed, and due to heterogeneity, narrative analysis performed. Cochrane risk of bias and GRADE assessment tools were used to assess bias and quality of evidence, allowing us to make recommendations regarding specific non-pharmacologic rehabilitation in older stroke survivors. In total, 72 primary articles were reviewed spanning 14 types of non-pharmacological intervention. Non-pharmacological interventions based on physiotherapy and occupational therapy techniques improved activities of daily living amongst older stroke survivors. However, no evidence was found to support use of any non-pharmacological approach to benefit older stroke survivors’ disability. Evidence was limited by poor study quality and the small number of studies targeting older stroke survivors. We recommend future studies explore such interventions exclusively in older adult populations and improve methodological and outcome reporting.

Highlights

Stroke remains a leading cause of death and disability, with older adults disproportionately affected[1,2]
Using the GRADE system the results suggest the evidence is of low quality, meaning that further studies are very likely to change the effect estimate
Our current review identified limited evidence to support the use of device assisted physiotherapy to enhance older stroke survivors stroke rehabilitation

Summary

Introduction

Stroke remains a leading cause of death and disability, with older adults disproportionately affected[1,2]. While effective acute treatment has increased stroke survival within developed nations, increased survival increases the number of those affected by post-stroke impairments [2]. Effective rehabilitation which can reduce post-stroke impairment and restore a person’s functional abilities is imperative. Stroke guidelines recommend utilising multi-disciplinary stroke rehabilitation teams [3,4,5]. This reflects the diverse physical, psychological and social rehabilitation needs of stroke survivors [3,4,5]. The patient’s age is generally accepted to be highly influential; older patients are at a higher risk of poorer outcomes following stroke rehabilitation [7]

Methods

Results

Discussion

Conclusion