National survey of Canadian occupational therapists' assessment and treatment of cognitive impairment post-stroke

Abstract

Aim: This study examined variations in management of cognitive impairment post-stroke among occupational therapists and factors associated with variations in practice.

Methods: Canada-wide cross-sectional telephone survey. Clinicians' practices were examined using standard patient cases (vignettes).

Setting: Acute care, inpatient rehabilitation and community-based sites providing stroke rehabilitation in all Canadian provinces.

Participants: Occupational therapists (n=663) working in stroke rehabilitation as identified through provincial licensing bodies.

Main outcome measures: Type and frequency of cognition-related problem identification, assessment and intervention use.

Results: Respectively, 69%, 83% and 31% of occupational therapists responding to the acute care, inpatient rehabilitation and community-based vignettes recognised cognition as a potential problem. Standardised assessment use was prevalent: 70% working in acute care, 77% in inpatient rehabilitation and 58% in community-based settings indicated using standardised assessments: 81%, 83% and 50%, respectively, indicated using general cognitive interventions.

Conclusion: The Mini-Mental State Examination was often used incorrectly to monitor patient change. Executive function, a critical component of post-stroke assessment, was rarely addressed. Interventions were most often general (e.g. incorporated in activities of daily living) rather than specific (e.g. cueing, memory aids, computer-based retraining).