Implementing Evidence-Based Somatosensory Rehabilitation After Stroke: Reported Practice, Documented Practice, and Barriers.

چکیده اصلی

INTRODUCTION: Occupational therapists play a key role in assessing and treating somatosensory impairments post stroke including proprioception (limb position sense), touch, and temperature discrimination. Although research evidence and clinical guidelines offer strategies for assessing and treating this condition, there is limited information on how well these strategies are being implemented in routine practice. We aimed to describe the current practice of occupational therapists in somatosensory assessment and treatment of the upper limb of stroke survivors and to understand barriers and enablers to evidence-based care. METHODS: This observational study encompassed (1) a cross-sectional survey measuring self-reported use of somatosensory assessment and treatment strategies and perceived barriers to implementation and (2) a medical file audit to report on the use of somatosensory assessment and treatment with stroke patients. Data were analyzed descriptively, with enablers and barriers to evidence use classified using the three domains of the Capability, Opportunity, Motivation-Behavior (COM-B) change model. RESULTS: Of 50 files audited, 26 patients had documented upper limb impairment. Of these, 54% had sensation assessed. Treatment strategies were documented for 7 out of 12 patients with identified impairment. These findings aligned with therapist self-report, indicating that most clinicians used sensory assessment and treatment strategies less than once per month. Therapists reported capability (lack of skills and skill confidence) and opportunity (lack of time and opportunity to practice skills) as barriers to evidence-based practice. Occupational therapists expressed motivation to change and improve their skills in evidence-based sensory assessment and treatment. CONCLUSION: Our findings highlight ongoing gaps between evidence and practice. Therapists report being motivated to provide evidence-based care but require support to overcome barriers, such as training and access to resources. Medical record audits aligned with survey findings; however, there were differences between reported and documented use and scope of sensory assessment and treatment in practice.

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