Effect of occupational therapy on upper limb function and related rehabilitation outcomes after stroke: a systematic review and meta-analysis

Background: Stroke is a major cause of disability worldwide, often leading to upper limb dysfunction, reduced daily living ability, and depression. Occupational therapy (OT) is recommended in rehabilitation guidelines, yet evidence on its comprehensive effects across physical and psychological outcomes in stroke survivors remains limited. Objective: This systematic review and meta-analysis aimed to provide the most up-to-date and comprehensive evaluation of the effects of OT on upper limb function, daily living ability, and depressive symptoms in stroke patients. Method: Eight English and Chinese databases were searched to August 2025 for RCTs comparing OT with standard rehabilitation in stroke patients. Outcomes included upper limb function, ADL, and depressive symptoms. Risk of bias was assessed with the Cochrane tool, and certainty of evidence with GRADE. Meta-analyses were conducted in RevMan 5.4 and Stata 18.0, with sensitivity and subgroup analyses by intervention setting, OT type, and duration. The complete search strategies (full electronic search strings for each database) are provided in Appendix 2. Results: < 0.00001) compared with controls. Subgroup analyses suggested larger effects in certain settings, with specific intervention types, and with longer (>8 weeks) durations, particularly for motor recovery. Sensitivity analyses confirmed result stability, and GRADE certainty was rated moderate for all outcomes. Conclusion: OT significantly improves upper limb function, daily living ability, and depressive symptoms in stroke patients, with greater gains seen in longer-term and structured programs, supporting its integration into post-stroke rehabilitation. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251122701.