Changing practice in the assessment and treatment of somatosensory loss in stroke survivors: An Implementation study

Two participant groups are provided with interventions: 1. Clinicians (occupational therapists and physiotherapists) 2. Stroke survivors presenting with sensory loss Participant Group 1 (Clinicians): Theory-based implementation strategies (i.e, group educational workshops and interactive online resources) will be provided to occupational therapists and physiotherapists working with stroke survivors from participating health organisations. Examples of theory-based implementation strategies to be used are: 1. Barrier identification and evaluation through implementation questionnaires 2. Group-based educational workshops providing training in evidence-based assessment and treatment methods for post-stroke somatosensory loss (the SENSe approach, Carey et al., 2011) 3. Establishment of site-specific champion-therapists through liaison between participating sites and the research team 4. Provision of written materials and online resources relevant to post-stroke sensory assessment and treatment. Carey, L.M, Macdonell, R., & Matyas, T. A. (2011). SENSe: Study of the Effectiveness of Neurorehabilitation on Sensation A Randomized Controlled Trial. Neurorehabilitation and neural repair, 25(4), 304-313. Theoretical approaches to guide implementation interventions will be based primarily on the Theoretical Domains Framework and the Behaviour Change Wheel (Cane et al., 2012; Michie et al., 2005; Michie, van Stralen & West, 2011). Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci. 2011; 6(1): 42. Michie, S., Johnston, M., Abraham, C., Lawton, R., Parker, D., & Walker, A. (2005). Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality and safety in health care, 14(1), 26-33. Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Science, 7(1), 37. Therapists will be up-skilled in assessment (training sessions of ~ 5 hours, over 3 sessions across 3 weeks ) and treatment (training sessions of ~8 hours, over 3 sessions across 3 weeks) approaches using interactive workshops facilitated by trained clinical researchers and involving multimedia resources. Participant Group 2 (Stroke survivors): Stroke survivors will be provided with SENSe therapy or usual care. SENSe is an upper limb therapy package for use with stroke survivors (Carey et al., 2011) comprising modules to train: * Tactile discrimination * Limb position sense * Tactile object recognition * Occupational performance in tasks selected as meaningful by the client Carey, L.M, Macdonell, R., & Matyas, T. A. (2011). SENSe: Study of the Effectiveness of Neurorehabilitation on Sensation A Randomized Controlled Trial. Neurorehabilitation and neural repair, 25(4), 304-313. Stroke survivors will receive 10 therapy sessions of 60 minute duration with sessions aimed at a rate of 3 per week, with variations depending on the nature of service delivery of participating sites. SENSe therapy sessions are one-on-one between therapist and patient. Usual care, as comparison to SENSe therapy, will constitute the therapy currently being provided to treat stroke survivors with sensory loss and the frequency of sessions and timeframes for delivery will be dependent on usual practices of participating sites. Details of therapy provided as part of usual care will be monitored via a questionnaire and results will be interpreted with reference to ‘usual care’ as defined by a recent cross-sectional study of 172 therapists across Australia (Pumpa et al., 2015). Pumpa, L., Cahill, L., & Carey, L.M. (2015). Somatosensory assessment and treatment after stroke: An evidence practice gap. Australian Occupational Therapy Journal. 62(2). Phases of this study include: Phase 1: Therapists implement evidence-based quantitative assessment of sensation using the SENSeAssess tool. Treatment approaches to address sensory loss remain unchanged (usual care). Phase 1 will commence after 3 weeks of SENSe Assess training has been completed. Phase 2: Therapists implement an evidence-based treatment approach (SENSe Therapy) with stroke clients. Stroke survivors will receive 10 therapy sessions of 60 minute duration. SENSe therapy sessions are one-on-one between therapist and patient. Phase 2 will commence after 3 weeks of SENSe therapy training has been completed.