National survey of Canadian occupational therapists’ assessment and treatment of cognitive impairment post‐stroke

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).