22. European Stroke Conference 2023 Very old patients with multiple diseases including stroke for nurses and physiotherapists A Cochrane systematic review of occupational therapy for care home residents with stroke J.C. Fletcher-Smith1, C.S. Cobley2, M.F. Walker3, E.M.J. Steultjens4, C.M. Sackley5 University of Nottingham, Nottingham, UNITED KINGDOM1, University of Nottingham, Not-tingham, UNITED KINGDOM2, University of Nottingham, Nottingham, UNITED KINGDOM3, University of Applied Sciences HAN, Nijmegen, THE NETHERLANDS4, University of East An-glia, Norwich, UNITED KINGDOM5 Background Around a quarter of care home residents in the USA and UK have had a stroke. Stroke is reported to be the second most common cause of disability after dementia in a UK nursing home population. 75% of care home residents are classified as being severely disabled and those with stroke have been described as a clinically complex population of frail elderly persons with a high prevalence of co-morbid conditions. It is not known whether the same benefits of occupational therapy found amongst community-dwelling stroke survivors, would be seen in the care home population. This systematic review aimed to measure the effects of occupational therapy interventions targeted at im-proving, restoring and maintaining independence in activities of daily living (ADL) among stroke survivors residing in care homes. Methods The lead reviewer searched the Cochrane Stroke Group Trials Register, the Cochrane Central Reg-ister of Controlled Trials, MEDLINE, EMBASE, CINAHL and nine other databases; four trials registers; three ongoing trials registers; and hand searched seven journals. Randomised trials investi-gating the impact of an occupational therapy intervention for care home residents with stroke versus standard care were selected for inclusion. Two reviewers independently assessed all titles and ab-stracts, selected trials for inclusion, and independently extracted the data to ensure reliability, with a third reviewer resolving any discrepancies. The primary outcomes were performance in ADL at the end of scheduled follow-up, and death or a poor outcome. Results The search strategy resulted in 1436 unduplicated titles. Of these, nine studies were reviewed in full. One study, involving 118 participants met the inclusion criteria for inclusion in the review. One on-going study also met the inclusion criteria but no data was yet available. Conclusion There was insufficient data to determine whether occupational therapy interventions can improve or maintain independence in ADL for care home residents with stroke. 208 © 2013 S. Karger AG, Basel 7. Nurses & AHP‘s Meeting 2024 Physiotherapy and early rehabilitation including intensive care and artificial respiration ICONS: Identifying Continence OptioNs after Stroke: Findings From a Randomised Trial. L.H. Thomas1, C.L. Watkins2, D. Forshaw3, B. French4, C.J. Sutton5, M.J. Leathley6, B. Roe7, J. Booth8, C.R. Burton9, E.M. McColl10, F. Cheater11, B. Carter12, K. Brittain13, H. Rodgers14, A. Walk-er15 On behalf of the ICONS Project Team and the ICONS Patient, Public and Carer Involvement Groups. University of Central Lancashire, Preston, UNITED KINGDOM1, University of Central Lan-cashire, Preston, UNITED KINGDOM2, University of Central Lancashire, Preston, UNITED KINGDOM3, University of Central Lancashire, Preston, UNITED KINGDOM4, University of Cen-tral Lancashire, Preston, UNITED KINGDOM5, University of Central Lancashire, Preston, USA6, Edge Hill University, Ormskirk, UNITED KINGDOM7, Glasgow Caledonian University, Glasgow, UNITED KINGDOM8, Bangor University, Bangor, UNITED KINGDOM9, Newcastle University, Newcastle upon Tyne, UNITED KINGDOM10, University of East Anglia, Norwich, UNITED KINGDOM11, University of Central Lancashire, Preston, UNITED KING-DOM12, Newcastle University, Newcastle upon Tyne, UNITED KINGDOM13, Newcastle Universi-ty, Newcastle upon Tyne, UNITED KINGDOM14, Glasgow University, Glasgow, UNITED KING-DOM15 Background Urinary incontinence following acute stroke affects between 40%-60% of hospitalised patients. National audit data suggest incontinence is often poorly managed. Conservative interventions (e.g. bladder training) have been shown by Cochrane reviews to have some effect, but have not been test-ed with stroke patients. Methods A cluster randomised controlled pilot trial designed to provide preliminary evidence of the effec-tiveness of a systematic voiding programme (SVP) for the management of continence after stroke. Stroke services were randomised to receive the SVP, the SVP plus supported implementation (using facilitation to embed the SVP into routine practice), or usual care. The primary outcome was presence/absence of urinary incontinence (Incontinence Impact Ques-tionnaire, Avery et al 2004). Secondary outcomes included severity of urinary incontinence (Incon-tinence Severity Index, Sandvik et al 2006) and quality of life. Outcomes were measured at six (pri-mary outcome point), 12 and 52 weeks after stroke. Results 413 participants from 12 stroke services were recruited; 164 received the SVP, 125 the SVP plus supported implementation and 124 usual care. At six weeks, for continence we found: odds ratio (continent) SVP alone (vs. usual care) 0.90 (95%CI 0.51 to 1.62); odds ratio (continent) SVP + supported implementation (vs. usual care) 0.59 (95%CI 0.34 to 1.03) and for severity: odds ratio (worse) SVP alone (vs. usual care) 1.20 (95%CI 0.69 to 2.09); odds ratio (worse) SVP + supported implementation (vs. usual care) 1.34 (95%CI 0.78 to 2.30). Conclusion Intervention groups showed no evidence of benefit compared with usual care on either continence or ist severity at six weeks. Time from stroke onset to starting the programme was longer than antici-pated with many yet to start or on it for a short time at six weeks post-stroke. Outcome at 12 weeks may provide a more realistic picture of preliminary effectiveness; findings will be presented at the Conference.
Karger_ESC London_2013
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