What is “usual care” in the rehabilitation of upper limb sensory loss after stroke? Results from a national audit and knowledge translation study

Abstract

Purpose

To characterise the assessments and treatments that comprise “usual care” for stroke patients with somatosensory loss, and whether usual care has changed over time.

Materials and methods

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.

Results

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%).

Conclusion

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: ACTRN12615000933550

IMPLICATIONS FOR REHABILITATION

• Only 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.

Keywords:

• Stroke
• somatosensory disorders
• upper extremity
• health services research
• clinical audit

Acknowledgements

We acknowledge the hospitals participating in the National Stroke Audit and the clinicians who contributed to data collection using the Australian Stroke Data Tool (AuSDaT). We acknowledge the work of Monique Kilkenny for her role in the Stroke Foundation National Audit program. We acknowledge and thank the occupational therapists and physiotherapists who took the time to complete practice reports for their patients in the SENSe Implement study.

Ethical approval

Ethics approval for data used in this project was granted through Monash University Human Ethics Committee (Project ID 8842) (Study 1, The Audit Program), and from Austin Health Human Research Ethics Committee (H2013/04956 HREC/13/Austin/8) and La Trobe University Human Ethics Committee (FHEC 14/243) (Study 2, The SENSe Implement Study).

Author contributions

LSC, DC, NAL, and LMC conceptualised the study. TP and LSC conducted data analysis of national audit data. LSC and YMY were involved in data collection and analysis in the knowledge translation study, with supervision and adjudication from LMC. LSC drafted the manuscript. All other authors (DC, LMC, NAL, DOC, TP, and YMY) read the manuscript and provided feedback for revision.

Disclosure statement

LMC is the lead originator of the SENSe approach to sensory rehabilitation, the focus of knowledge translation in The SENSe Implement project. LMC has no personal financial interest in the sale of the SENSe training package (manual and DVD). There is no patent, or intended application for a patent, associated with these resources. All other authors declare that they have no competing interests.

Additional information

Funding

This work was supported by National Health and Medical Research Council (NHMRC) of Australia partnership grants: A network of sites and “up-skilled” therapists to deliver best practice stroke rehabilitation of the upper limb (GNT 1134495) and Ideas grant: Staying connected: personalising stroke recovery and rehabilitation through new technologies for people with stroke living at home (GNT143480). LSC and YMY are supported by La Trobe University Post-Graduate Scholarships. NAL is supported by a Future Leader Fellowship (102055) from the National Heart Foundation of Australia. DC is supported by a research fellowship from the National Health and Medical Research Council (NHMRC) (1063761 co-funded by the Heart Foundation; 1154273). DAO is supported by an NHMRC Translating Research into Practice Fellowship (GNT 1168749).