Non-pharmacological interventions for the improvement of post-stroke quality of life amongst older stroke survivors

a systematic review (The SENATOR ONTOP series)

Carrie L. Stewart (Corresponding Author), Selvarani Subbarayan, Pamela Paton, Elliot Gemmell, Iosief Abraha, Phyo K. Myint, D. O'Mahony, Antonio Cherubini, Alfonso J. Cruz-Jentoft, Roy L Soiza

Research output: Contribution to journalArticle

Abstract

Purpose
The efficacy of non-pharmacological stroke rehabilitation approaches for older stroke survivors is largely unknown, particularly in relation to psychosocial outcomes such as quality of life. 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].

Methods
Thirteen experts in geriatric medicine, as part of a Delphi panel, agreed quality of life to be a critical outcome of stroke rehabilitation. A comprehensive search strategy was developed and databases were searched for eligible systematic reviews from which trials meeting our criteria were identified. Eligible papers were then double reviewed. Due to heterogeneity, narrative analysis was performed. Cochrane risk of bias and GRADE assessment tools were used to assess bias and quality of evidence.

Results
We identified 28 trials, spanning ten types of intervention. Limited evidence supports the use of additional occupational therapy and physiotherapy, with very limited evidence supporting our recommendation to explore caregiver training, constraint-induced movement therapy, device-assisted physiotherapy, and self-management education further.

Conclusion
Limited evidence suggests a range of non-pharmacological interventions may improve the quality of life of older stroke survivors. However, evidence is limited by low 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.
Original languageEnglish
Pages (from-to)359-386
Number of pages28
JournalEuropean Geriatric Medicine
Volume10
Issue number3
Early online date2 Apr 2019
DOIs
Publication statusPublished - Jun 2019

Fingerprint

Survivors
Stroke
Quality of Life
Occupational Therapy
European Union
Self Care
Geriatrics
Caregivers
Therapeutics
Software
Medicine
Databases
Education
Equipment and Supplies
Pharmaceutical Preparations
Population
Stroke Rehabilitation

Keywords

  • older adults
  • ageing
  • stroke
  • rehabilitation
  • non-pharmacological therapies
  • Stroke
  • Ageing
  • Rehabilitation
  • Older adults
  • Non-pharmacological therapies

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Gerontology

Cite this

Non-pharmacological interventions for the improvement of post-stroke quality of life amongst older stroke survivors : a systematic review (The SENATOR ONTOP series) . / Stewart, Carrie L. (Corresponding Author); Subbarayan, Selvarani; Paton, Pamela; Gemmell, Elliot ; Abraha, Iosief; Myint, Phyo K.; O'Mahony, D.; Cherubini, Antonio; Cruz-Jentoft, Alfonso J. ; Soiza, Roy L.

In: European Geriatric Medicine, Vol. 10, No. 3, 06.2019, p. 359-386.

Research output: Contribution to journalArticle

Stewart, Carrie L. ; Subbarayan, Selvarani ; Paton, Pamela ; Gemmell, Elliot ; Abraha, Iosief ; Myint, Phyo K. ; O'Mahony, D. ; Cherubini, Antonio ; Cruz-Jentoft, Alfonso J. ; Soiza, Roy L. / Non-pharmacological interventions for the improvement of post-stroke quality of life amongst older stroke survivors : a systematic review (The SENATOR ONTOP series) . In: European Geriatric Medicine. 2019 ; Vol. 10, No. 3. pp. 359-386.
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abstract = "PurposeThe efficacy of non-pharmacological stroke rehabilitation approaches for older stroke survivors is largely unknown, particularly in relation to psychosocial outcomes such as quality of life. 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].MethodsThirteen experts in geriatric medicine, as part of a Delphi panel, agreed quality of life to be a critical outcome of stroke rehabilitation. A comprehensive search strategy was developed and databases were searched for eligible systematic reviews from which trials meeting our criteria were identified. Eligible papers were then double reviewed. Due to heterogeneity, narrative analysis was performed. Cochrane risk of bias and GRADE assessment tools were used to assess bias and quality of evidence.ResultsWe identified 28 trials, spanning ten types of intervention. Limited evidence supports the use of additional occupational therapy and physiotherapy, with very limited evidence supporting our recommendation to explore caregiver training, constraint-induced movement therapy, device-assisted physiotherapy, and self-management education further.ConclusionLimited evidence suggests a range of non-pharmacological interventions may improve the quality of life of older stroke survivors. However, evidence is limited by low 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.",
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note = "Funding This review was completed as part of a series of systematic reviews conducted as part of the SENATOR programme, a collaborative project funded by the European Union under the 7th Framework Programme (FP7/2007-2013) under grant agreement number 305930 (www.senator-project.eu). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.",
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AU - Subbarayan, Selvarani

AU - Paton, Pamela

AU - Gemmell, Elliot

AU - Abraha, Iosief

AU - Myint, Phyo K.

AU - O'Mahony, D.

AU - Cherubini, Antonio

AU - Cruz-Jentoft, Alfonso J.

AU - Soiza, Roy L

N1 - Funding This review was completed as part of a series of systematic reviews conducted as part of the SENATOR programme, a collaborative project funded by the European Union under the 7th Framework Programme (FP7/2007-2013) under grant agreement number 305930 (www.senator-project.eu). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

PY - 2019/6

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N2 - PurposeThe efficacy of non-pharmacological stroke rehabilitation approaches for older stroke survivors is largely unknown, particularly in relation to psychosocial outcomes such as quality of life. 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].MethodsThirteen experts in geriatric medicine, as part of a Delphi panel, agreed quality of life to be a critical outcome of stroke rehabilitation. A comprehensive search strategy was developed and databases were searched for eligible systematic reviews from which trials meeting our criteria were identified. Eligible papers were then double reviewed. Due to heterogeneity, narrative analysis was performed. Cochrane risk of bias and GRADE assessment tools were used to assess bias and quality of evidence.ResultsWe identified 28 trials, spanning ten types of intervention. Limited evidence supports the use of additional occupational therapy and physiotherapy, with very limited evidence supporting our recommendation to explore caregiver training, constraint-induced movement therapy, device-assisted physiotherapy, and self-management education further.ConclusionLimited evidence suggests a range of non-pharmacological interventions may improve the quality of life of older stroke survivors. However, evidence is limited by low 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.

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