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Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Study protocol

Changing practice in the assessment and treatment of somatosensory loss in stroke survivors: protocol for a knowledge translation study

Authors: Liana S. Cahill, Natasha A. Lannin, Yvonne Y. K. Mak-Yuen, Megan L. Turville, Leeanne M. Carey

Published in: BMC Health Services Research | Issue 1/2018

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Abstract

Background

The 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/design

A 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.

Discussion

This study will provide evidence and a template for knowledge translation in clinical, organizational and policy contexts in stroke rehabilitation.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR) retrospective registration ACTRN12615000933​550.
Appendix
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Literature
1.
go back to reference Carey LM. Somatosensory loss after stroke. Crit Rev Phys Rehabil Med. 1995;7:51–91.CrossRef Carey LM. Somatosensory loss after stroke. Crit Rev Phys Rehabil Med. 1995;7:51–91.CrossRef
2.
go back to reference Carey LM, Matyas TA. Frequency of discriminative sensory loss in the hand after stroke. J Rehabil Med. 2011;43:257–63.CrossRefPubMed Carey LM, Matyas TA. Frequency of discriminative sensory loss in the hand after stroke. J Rehabil Med. 2011;43:257–63.CrossRefPubMed
3.
go back to reference Connell LA, Lincoln NB, Radford KA. Somatosensory impairment after stroke: frequency of different deficits and their recovery. Clin Rehabil. 2008;22(8):758–67.CrossRefPubMed Connell LA, Lincoln NB, Radford KA. Somatosensory impairment after stroke: frequency of different deficits and their recovery. Clin Rehabil. 2008;22(8):758–67.CrossRefPubMed
4.
go back to reference Tyson SF, Hanley M, Chillala J, Selley AB, Tallis RC. Sensory loss in hospital-admitted people with stroke: characteristics, associated factors, and relationship with function. Neurorehabil and Neural Repair. 2008;22(2):166–72.CrossRef Tyson SF, Hanley M, Chillala J, Selley AB, Tallis RC. Sensory loss in hospital-admitted people with stroke: characteristics, associated factors, and relationship with function. Neurorehabil and Neural Repair. 2008;22(2):166–72.CrossRef
5.
go back to reference Kim JS, Choi-Kwon S. Discriminative sensory dysfunction after unilateral stroke. Stroke. 1996;27(4):677–82.CrossRefPubMed Kim JS, Choi-Kwon S. Discriminative sensory dysfunction after unilateral stroke. Stroke. 1996;27(4):677–82.CrossRefPubMed
6.
go back to reference Kalra L. Stroke rehabilitation 2009: old chestnuts and new insights. Stroke. 2010;41(2):88–90.CrossRef Kalra L. Stroke rehabilitation 2009: old chestnuts and new insights. Stroke. 2010;41(2):88–90.CrossRef
7.
go back to reference Pumpa LU, Cahill LS, Carey LM. Somatosensory assessment and treatment after stroke: an evidence-practice gap. Aust Occup Ther J. 2015;62(2):93–104.CrossRefPubMed Pumpa LU, Cahill LS, Carey LM. Somatosensory assessment and treatment after stroke: an evidence-practice gap. Aust Occup Ther J. 2015;62(2):93–104.CrossRefPubMed
8.
go back to reference Doyle S, Bennett S, Gustafsson L. Occupational therapy for upper limb post-stroke sensory impairments: a survey. Br J Occup Ther. 2013;76(10):434–42.CrossRef Doyle S, Bennett S, Gustafsson L. Occupational therapy for upper limb post-stroke sensory impairments: a survey. Br J Occup Ther. 2013;76(10):434–42.CrossRef
9.
go back to reference Carey LM. Touch and body sensations. In: Carey LM, editor. Stroke rehabilitation: insights from neuroscience and imaging. New York: Oxford University Press; 2012. p. 157–72.CrossRef Carey LM. Touch and body sensations. In: Carey LM, editor. Stroke rehabilitation: insights from neuroscience and imaging. New York: Oxford University Press; 2012. p. 157–72.CrossRef
10.
go back to reference Blennerhassett JM, Matyas TA, Carey LM. Impaired discrimination of surface friction contributes to pinch grip deficit after stroke. Neurorehabil and Neural Repair. 2007;21(3):263–72.CrossRef Blennerhassett JM, Matyas TA, Carey LM. Impaired discrimination of surface friction contributes to pinch grip deficit after stroke. Neurorehabil and Neural Repair. 2007;21(3):263–72.CrossRef
11.
go back to reference Smania N, Montagnana B, Faccioli S, Fiaschi A, Aglioti SM. Rehabilitation of somatic sensation and related deficit of motor control in patients with pure sensory stroke. Arch Phys Med Rehabil. 2003;84(11):1692–702.CrossRefPubMed Smania N, Montagnana B, Faccioli S, Fiaschi A, Aglioti SM. Rehabilitation of somatic sensation and related deficit of motor control in patients with pure sensory stroke. Arch Phys Med Rehabil. 2003;84(11):1692–702.CrossRefPubMed
12.
go back to reference Carey LM, Lamp G, Turville M. The state-of-the-science on somatosensory function and its impact on daily life in adults, older adults and following stroke: a scoping review. OTJR: Occupation, Participation and Health. 2016;36(2 Suppl):27S–41S.PubMed Carey LM, Lamp G, Turville M. The state-of-the-science on somatosensory function and its impact on daily life in adults, older adults and following stroke: a scoping review. OTJR: Occupation, Participation and Health. 2016;36(2 Suppl):27S–41S.PubMed
13.
go back to reference Carey LM, Macdonell R, Matyas TA. SENSe: study of the effectiveness of neurorehabilitation on sensation: a randomized controlled trial. Neurorehabil and Neural Repair. 2011;25:304–13.CrossRef Carey LM, Macdonell R, Matyas TA. SENSe: study of the effectiveness of neurorehabilitation on sensation: a randomized controlled trial. Neurorehabil and Neural Repair. 2011;25:304–13.CrossRef
15.
17.
go back to reference Walker MF, Fisher RJ, Korner-Bitensky N, McCluskey A, Carey LM. From what we know to what we do: translating stroke rehabilitation research into practice. Int J Stroke. 2013;8(1):11–7.CrossRefPubMed Walker MF, Fisher RJ, Korner-Bitensky N, McCluskey A, Carey LM. From what we know to what we do: translating stroke rehabilitation research into practice. Int J Stroke. 2013;8(1):11–7.CrossRefPubMed
18.
go back to reference Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? J Contin Educ Heal Prof. 2006;26(1):13–24.CrossRef Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? J Contin Educ Heal Prof. 2006;26(1):13–24.CrossRef
21.
go back to reference Moullin JC, Sabater-Hernandez D, Fernandez-Llimos F, Benrimoj SI. A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework. Health Res Policy Syst. 2015;13:16.CrossRefPubMedPubMedCentral Moullin JC, Sabater-Hernandez D, Fernandez-Llimos F, Benrimoj SI. A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework. Health Res Policy Syst. 2015;13:16.CrossRefPubMedPubMedCentral
22.
go back to reference Gardner B, Whittington C, McAteer J, Eccles MP, Michie S. Using theory to synthesise evidence from behaviour change interventions: the example of audit and feedback. Soc Sci Med. 2010;70(10):1618–25.CrossRefPubMed Gardner B, Whittington C, McAteer J, Eccles MP, Michie S. Using theory to synthesise evidence from behaviour change interventions: the example of audit and feedback. Soc Sci Med. 2010;70(10):1618–25.CrossRefPubMed
23.
go back to reference Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14(1):26–33.CrossRefPubMedPubMedCentral Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14(1):26–33.CrossRefPubMedPubMedCentral
24.
go back to reference Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7(1):37.CrossRefPubMedPubMedCentral Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7(1):37.CrossRefPubMedPubMedCentral
25.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
26.
go back to reference May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology. 2009;43(3):535–54.CrossRef May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology. 2009;43(3):535–54.CrossRef
27.
go back to reference McEvoy R, Ballini L, Maltoni S, O'Donnell CA, Mair FS, MacFarlane AA. Qualitative systematic review of studies using the normalisation process theory to research implementation processes. Implement Sci. 2014;9(2):1–13. McEvoy R, Ballini L, Maltoni S, O'Donnell CA, Mair FS, MacFarlane AA. Qualitative systematic review of studies using the normalisation process theory to research implementation processes. Implement Sci. 2014;9(2):1–13.
28.
go back to reference Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf FM, Davis D, Odgarrd-Jensen J, Oxman AD. Continuing education meetings and workshops: effects on professional practice and health care outcomes (review). Cochrane Database Syst Rev. 2009;2. Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf FM, Davis D, Odgarrd-Jensen J, Oxman AD. Continuing education meetings and workshops: effects on professional practice and health care outcomes (review). Cochrane Database Syst Rev. 2009;2.
29.
go back to reference Giguere A, Legare F, Grimshaw J, Turcotte S, Fiander M, Grudniewicz A, Makosso-Kallyth S, Wolf FM, Farmer AP, Gagnon MP. Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;10. Giguere A, Legare F, Grimshaw J, Turcotte S, Fiander M, Grudniewicz A, Makosso-Kallyth S, Wolf FM, Farmer AP, Gagnon MP. Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;10.
30.
go back to reference O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, Forsetlund L, Bainbridge D, Freemantle N, Davis D, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007;4. O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, Forsetlund L, Bainbridge D, Freemantle N, Davis D, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007;4.
31.
go back to reference Flodgren G, Parmelli E, Doumit G, Gattellari M, O'Brien MA, Grimshaw J, Eccles MP. Local opinion leaders: effects on professional practice and health care outcomes (review). Cochrane Database Syst Rev. 2011;8. Flodgren G, Parmelli E, Doumit G, Gattellari M, O'Brien MA, Grimshaw J, Eccles MP. Local opinion leaders: effects on professional practice and health care outcomes (review). Cochrane Database Syst Rev. 2011;8.
32.
go back to reference Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O'Brien MA, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;6. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O'Brien MA, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;6.
33.
go back to reference Carey L, Mak Y, Tan AM, Rickard K, Matyas TA. Development of a somatosensory screening tool for use in clinical rehabilitation settings with stroke survivors. Stroke Society of Australasia. Int J Stroke. 2013;8 Suppl 1:1–51. doi:https://doi.org/10.1111/ijs.12140. Carey L, Mak Y, Tan AM, Rickard K, Matyas TA. Development of a somatosensory screening tool for use in clinical rehabilitation settings with stroke survivors. Stroke Society of Australasia. Int J Stroke. 2013;8 Suppl 1:1–51. doi:https://​doi.​org/​10.​1111/​ijs.​12140.
34.
go back to reference Carey L, Oke L, Matyas TA. Impaired touch discrimination after stroke: a quantitative test. Neurorehabil and Neural Repair. 1997;11:219–32.CrossRef Carey L, Oke L, Matyas TA. Impaired touch discrimination after stroke: a quantitative test. Neurorehabil and Neural Repair. 1997;11:219–32.CrossRef
35.
go back to reference Carey LM, Oke LE, Matyas TA. Impaired limb position sense after stroke: a quantitative test for clinical use. Arch Phys Med Rehabil. 1996;77:1271–8.CrossRefPubMed Carey LM, Oke LE, Matyas TA. Impaired limb position sense after stroke: a quantitative test for clinical use. Arch Phys Med Rehabil. 1996;77:1271–8.CrossRefPubMed
36.
go back to reference Carey L, Nankervis J, LeBlanc S, Harvey L. A new functional tactual object recognition test (fTORT) for stroke clients: Normative standards and discriminative validity. Sydney, Australia: 14th International Congress of the World Federation of Occupational Therapists.; 2006. Carey L, Nankervis J, LeBlanc S, Harvey L. A new functional tactual object recognition test (fTORT) for stroke clients: Normative standards and discriminative validity. Sydney, Australia: 14th International Congress of the World Federation of Occupational Therapists.; 2006.
37.
go back to reference Blennerhassett J, Avery RM, Carey LM. The test-retest reliability and responsiveness to change for the hand function survey during stroke rehabilitation. Aust Occup Ther J. 2010;57(6):431–8.CrossRefPubMed Blennerhassett J, Avery RM, Carey LM. The test-retest reliability and responsiveness to change for the hand function survey during stroke rehabilitation. Aust Occup Ther J. 2010;57(6):431–8.CrossRefPubMed
38.
go back to reference Jebsen R, Taylor N, Trieschmann R, Trotter M, Howard L. An objective and standardized test of hand function. Arch Phys Med Rehabil. 1969;50:311–9.PubMed Jebsen R, Taylor N, Trieschmann R, Trotter M, Howard L. An objective and standardized test of hand function. Arch Phys Med Rehabil. 1969;50:311–9.PubMed
39.
go back to reference Law M, Baptiste S, McColl MA, Opzoomer A, Polatajko H, Pollock N. The canadian occupational performance measure: an outcome measure for occupational therapy. Can J Occup Ther. 1990;57(2):82–7.CrossRefPubMed Law M, Baptiste S, McColl MA, Opzoomer A, Polatajko H, Pollock N. The canadian occupational performance measure: an outcome measure for occupational therapy. Can J Occup Ther. 1990;57(2):82–7.CrossRefPubMed
40.
go back to reference Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRefPubMed Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRefPubMed
41.
go back to reference Des Jarlais DC, Lyles C, Crepaz N. Improving the reporting quality of nonrandomized evaluations of behavioural and public health interventions: the trend statement. Am J Public Health. 2004;94:361–6.CrossRefPubMedPubMedCentral Des Jarlais DC, Lyles C, Crepaz N. Improving the reporting quality of nonrandomized evaluations of behavioural and public health interventions: the trend statement. Am J Public Health. 2004;94:361–6.CrossRefPubMedPubMedCentral
42.
go back to reference Pinnock H, Barwick M, Carpenter CR, Eldridge S, Grandes G, Griffiths CJ et al. Standards for reporting implementation studies (StaRI) statement. BMJ. 2017;356:i6795. Pinnock H, Barwick M, Carpenter CR, Eldridge S, Grandes G, Griffiths CJ et al. Standards for reporting implementation studies (StaRI) statement. BMJ. 2017;356:i6795.
44.
go back to reference Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008 Sep 29;337:a1655. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008 Sep 29;337:a1655.
Metadata
Title
Changing practice in the assessment and treatment of somatosensory loss in stroke survivors: protocol for a knowledge translation study
Authors
Liana S. Cahill
Natasha A. Lannin
Yvonne Y. K. Mak-Yuen
Megan L. Turville
Leeanne M. Carey
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-2829-z

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