Cahill Liana S, Lannin Natasha A, Mak-Yuen Yvonne Y K, Turville Megan L, Carey Leeanne M
Occupational Therapy, School of Allied Health, La Trobe University, Bundoora, Australia.
Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.
BMC Health Serv Res. 2018 Jan 23;18(1):34. doi: 10.1186/s12913-018-2829-z.
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.
This study will provide evidence and a template for knowledge translation in clinical, organizational and policy contexts in stroke rehabilitation.
Australian New Zealand Clinical Trials Registry (ANZCTR) retrospective registration ACTRN12615000933550 .
中风后上肢体感丧失的治疗在历史上一直被专注于运动恢复的疗法所掩盖。一项双盲随机对照试验已证明SENSe(神经康复对感觉的有效性研究)疗法在中风后重新训练体感辨别能力方面的有效性。鉴于中风后上肢感觉丧失的公认患病率以及该领域存在的证据与实践差距,需要做出努力将已发表的研究转化为临床实践。本研究的目的是确定基于证据的知识转化策略是否会改变职业治疗师和物理治疗师在评估和治疗中风后上肢感觉丧失方面的实践,以改善患者预后。
方法/设计:一项实用的前后对照研究设计,涉及八个(n = 8)澳大利亚卫生组织,具体为亚急性和社区康复机构。中风幸存者(n = 144)以及职业治疗师和物理治疗师(每个机构约10名,约n = 80)将参与该研究。中风幸存者将接受SENSe疗法或常规护理。职业治疗师和物理治疗师将获得一种多成分的知识转化方法,包括:i)根据特定场所的障碍和促进因素调整实施干预措施;ii)互动式小组培训工作坊;iii)建立并培养优秀治疗师;iv)提供书面教育材料和在线资源。职业治疗师和物理治疗师的结局指标将是实施前和实施后的问卷以及病历审核。中风幸存者的主要结局将是使用标准化综合测量方法测量的上肢体感功能变化。
本研究将为中风康复的临床、组织和政策背景下的知识转化提供证据和模板。
澳大利亚新西兰临床试验注册中心(ANZCTR)回顾性注册ACTRN12615000933550 。