Adaptive Interventions for Enhancing Participation Poststroke: A Systematic Review and Meta-Analysis.

Abstract

Background: Stroke rehabilitation includes both restorative and adaptive interventions. There are few specific guidelines regarding adaptive interventions.

Purpose: To determine the effectiveness of adaptive interventions on participation outcomes generally, and more specifically by theoretical focus of the intervention.

Method: Systematic review. Relevant databases were searched for randomized controlled trials of adaptive interventions that included a participation measure. Data were extracted and Hedges' g was calculated for all interventions and then by intervention classification.

Results: Fourteen named interventions were examined in 24 studies. When all interventions were considered, the following was observed: a medium effect on person-specific participation goals that approached significance (0.60; [95% CI: -0.06; 1.26], p = .07), a negligible and non-significant effect on broad participation (0.10; [95% CI: -0.13; 0.33], p = .37), and a small to medium significant effect on instrumental activities of daily living (IADL; 0.37, [95% CI: 0.12; 0.62] p = .004). Studies evaluating person-specific participation were dominated by learning-focused interventions, while studies evaluating broad participation and IADL were dominated by coping-focused interventions.

Conclusion: Learning- or motivation-focused approaches appear to have an important impact on person-specific participation goals. Future research should focus on clarifying the effectiveness of these interventions and improving impact on broader participation.