Occupational therapy for persons with cognitive impairments.

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Health Technology Assessment

Background:

• Central nervous system (CNS) damage from stroke, trauma, or disease causes physical and cognitive impairments in adults.
• Occupational therapy is a common intervention for neurological conditions like stroke and traumatic brain injury (TBI).

Purpose of the Study:

• To assess the clinical effectiveness, cost-effectiveness, and patient-related, social, and ethical aspects of occupational therapy for cognitive impairments following CNS injury.
• To compare occupational therapy interventions with and without cognitive components.

Main Methods:

• A systematic overview of systematic reviews was conducted.
• Included nine systematic reviews for clinical effectiveness, five for patient/social aspects, and nine documents for ethical aspects.
• Excluded patients with moderate to severe dementia.

Main Results:

• Low-quality evidence suggests small positive effects of occupational therapy on global cognitive function and daily living activities.
• No significant effects were found for individual cognitive components or perception measures.
• Patient and social aspects highlight rehabilitation phases and the critical role of discharge home; ethical aspects reveal tensions between patient autonomy and treatment.

Conclusions:

• The effectiveness of occupational therapy for cognitive impairment post-CNS injury remains uncertain due to low-quality evidence and a lack of high-quality studies.
• Further research is required, including well-designed randomized trials, observational studies, health economic analyses, and empirical ethical studies.
• More studies are needed on patient and social aspects, particularly in German-speaking regions, and on ethical considerations involving patients, relatives, and therapists.