Abstract
BackgroundThe treatment of somatosensory loss in the upper limb after stroke has been historically overshadowed by therapy focused on motor recovery. A double-blind randomized controlled trial has demonstrated the effectiveness of SENSe (Study of the Effectiveness of Neurorehabilitation on Sensation) therapy to retrain somatosensory discrimination after stroke. Given the acknowledged prevalence of upper limb sensory loss after stroke and the evidence-practice gap that exists in this area, effort is required to translate the published research to clinical practice. The aim of this study is to determine whether evidence-based knowledge translation strategies change the practice of occupational therapists and physiotherapists in the assessment and treatment of sensory loss of the upper limb after stroke to improve patient outcomes.Method/designA pragmatic, before-after study design involving eight (n = 8) Australian health organizations, specifically sub-acute and community rehabilitation facilities. Stroke survivors (n = 144) and occupational therapists and physiotherapists (~10 per site, ~n = 80) will be involved in the study. Stroke survivors will be provided with SENSe therapy or usual care. Occupational therapists and physiotherapists will be provided with a multi-component approach to knowledge translation including i) tailoring of the implementation intervention to site-specific barriers and enablers, ii) interactive group training workshops, iii) establishing and fostering champion therapists and iv) provision of written educational materials and online resources. Outcome measures for occupational therapists and physiotherapists will be pre- and post-implementation questionnaires and audits of medical records. The primary outcome for stroke survivors will be change in upper limb somatosensory function, measured using a standardized composite measure.DiscussionThis study will provide evidence and a template for knowledge translation in clinical, organizational and policy contexts in stroke rehabilitation.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) retrospective registration ACTRN12615000933550.
Highlights
The treatment of somatosensory loss in the upper limb after stroke has been historically overshadowed by therapy focused on motor recovery
Similar findings came from the United States, where practice patterns of 145 occupational therapists were studied; 93% of those surveyed regularly assessed upper limb somatosensory function, though only half reported always or frequently providing interventions to target upper limb somatosensory loss [8]
In this paper we describe the study protocol for a project designed to address the knowledge-practice gap in delivery of an effective upper-limb neurorehabilitation therapy - Translating neurorehabilitation research into clinical practice: The SENSe Implement project
Summary
The treatment of somatosensory loss in the upper limb after stroke has been historically overshadowed by therapy focused on motor recovery. Given the acknowledged prevalence of upper limb sensory loss after stroke and the evidence-practice gap that exists in this area, effort is required to translate the published research to clinical practice. The aim of this study is to determine whether evidence-based knowledge translation strategies change the practice of occupational therapists and physiotherapists in the assessment and treatment of sensory loss of the upper limb after stroke to improve patient outcomes. Occupational therapists and physiotherapists play a crucial role in the assessment and treatment of somatosensory loss after stroke. The evidence-practice gap in somatosensory assessment and treatment after stroke was highlighted in a cross-sectional study of 172 occupational therapists and physiotherapists practicing in Australia [7]. Similar findings came from the United States, where practice patterns of 145 occupational therapists were studied; 93% of those surveyed regularly assessed upper limb somatosensory function, though only half reported always or frequently providing interventions to target upper limb somatosensory loss [8]
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