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

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

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

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.

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.

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.