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Title: What is "usual care" in the rehabilitation of upper limb sensory loss after stroke? Results from a national audit and knowledge translation study.
Austin Authors: Cahill, Liana S;Lannin, Natasha A;Purvis, Tara;Cadilhac, Dominique A;Mak-Yuen, Yvonne;O'Connor, Denise A;Carey, Leeanne M 
Affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
The Florey Institute of Neuroscience and Mental Health
School of Allied Health, Australian Catholic University, Melbourne, Australia
Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
Allied Health (Occupational Therapy), Alfred Health, Melbourne, Australia
Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
Public Health and Health Services Evaluation, Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Australia
Issue Date: 9-Sep-2021
Date: 2021-09-09
Publication information: Disability and Rehabilitation 2022; 44(21): 6462-6470
Abstract: To characterise the assessments and treatments that comprise "usual care" for stroke patients with somatosensory loss, and whether usual care has changed over time. Comparison of cross-sectional, observational data from (1) Stroke Foundation National Audit of Acute (2007-2019) and Rehabilitation (2010-2018) Stroke Services and (2) the SENSe Implement multi-site knowledge translation study with occupational therapists and physiotherapists (n = 115). Descriptive statistics, random effects logistic regression, and content analysis were used. Acute hospitals (n = 172) contributed 24 996 cases across audits from 2007 to 2019 (median patient age 76 years, 54% male). Rehabilitation services (n = 134) contributed organisational survey data from 2010 to 2014, with 7165 cases (median 76 years, 55% male) across 2016-2018 clinical audits (n = 127 services). Somatoensory assessment protocol use increased from 53% (2007) to 86% (2019) (odds ratio 11.4, 95% CI 5.0-25.6). Reported use of sensory-specific retraining remained stable over time (90-93%). Therapist practice reports for n = 86 patients with somatosensory loss revealed 16% did not receive somatosensory rehabilitation. The most common treatment approaches were sensory rehabilitation using everyday activities (69%), sensory re-education (68%), and compensatory strategies (64%). Sensory assessment protocol use has increased over time while sensory-specific training has remained stable. Sensory rehabilitation in the context of everyday activities is a common treatment approach. Clinical trial registration number: ACTRN12615000933550IMPLICATIONS FOR REHABILITATIONOnly a small proportion of upper limb assessments conducted with stroke patients focus specifically on sensation; increased use of standardised upper limb assessments for sensory loss is needed.Stroke patients assessed as having upper limb sensory loss frequently do not receive treatment for their deficits.Therapists typically use everyday activities to treat upper limb sensory loss and may require upskilling in sensory-specific retraining to benefit patients.
DOI: 10.1080/09638288.2021.1964620
ORCID: 0000-0002-1730-9843
Journal: Disability and Rehabilitation
PubMed URL: 34498991
Type: Journal Article
Subjects: Stroke
clinical audit
health services research
somatosensory disorders
upper extremity
Appears in Collections:Journal articles

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