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职业治疗师在急性期对中风后上肢感觉障碍的评估:一项探索当前临床实践的混合方法研究。

Assessment of sensory impairment of the upper limb post-stroke by occupational therapists within the acute setting: A mixed methods study exploring current clinical practice.

作者信息

Byrne Danielle, Cahill Liana S, Barr Christopher, George Stacey

机构信息

College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia.

Monash Health, Melbourne, Victoria, Australia.

出版信息

Br J Occup Ther. 2023 Dec;86(12):830-838. doi: 10.1177/03080226231184994. Epub 2023 Jul 8.

DOI:10.1177/03080226231184994
PMID:40336558
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12033519/
Abstract

INTRODUCTION

Sensory impairment of the upper limb is common after stroke and negatively impacts a stroke survivor's recovery. The acute phase is a critical time for the identification of post-stroke somatosensory impairments and occupational therapists have a key role in the acute stroke setting. Sensory assessment and treatment practices of occupational therapists working in acute stroke settings are largely unknown. This study aims to describe current clinical practice and identify the barriers and enablers for the assessment of sensory impairment in patients post stroke within acute stroke units.

METHOD

A mixed-methods approach was utilised, with an Australian national cross-sectional online survey of occupational therapists ( = 85) and state-based focus groups ( = 2). Descriptive analyses and thematic analysis were conducted.

FINDINGS

The majority of clinicians (78%) use non-standardised measures to assess for somatosensory impairment. Three qualitative themes were identified: acute setting contextual factors, individual patient characteristics and priorities, and clinician knowledge and perceived benefits.

CONCLUSION

Occupational therapists working within acute stroke units are aware of the importance of assessing sensory impairment of the upper limb post stroke. However, the majority use non-standardised approaches and called for a standardised quick-to-administer tool kit that is readily available in acute stroke units.

摘要

引言

中风后上肢感觉障碍很常见,对中风幸存者的康复产生负面影响。急性期是识别中风后躯体感觉障碍的关键时期,职业治疗师在急性中风治疗中起着关键作用。在急性中风环境中工作的职业治疗师的感觉评估和治疗实践在很大程度上尚不为人所知。本研究旨在描述当前的临床实践,并确定急性中风单元中中风后患者感觉障碍评估的障碍和促进因素。

方法

采用混合方法,对澳大利亚全国范围内的职业治疗师(n = 85)进行在线横断面调查,并开展基于州的焦点小组访谈(n = 2)。进行了描述性分析和主题分析。

结果

大多数临床医生(78%)使用非标准化方法评估躯体感觉障碍。确定了三个定性主题:急性环境背景因素、个体患者特征和优先事项,以及临床医生的知识和感知到的益处。

结论

在急性中风单元工作的职业治疗师意识到评估中风后上肢感觉障碍的重要性。然而,大多数人使用非标准化方法,并呼吁提供一个标准化的、易于实施的工具包,以便在急性中风单元中随时可用。

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本文引用的文献

1
Factors influencing allied health professionals' implementation of upper limb sensory rehabilitation for stroke survivors: a qualitative study to inform knowledge translation.影响康复治疗师对中风幸存者实施上肢感觉康复的因素:一项为知识转化提供信息的定性研究
BMJ Open. 2021 Feb 19;11(2):e042879. doi: 10.1136/bmjopen-2020-042879.
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The Functional Tactile Object Recognition Test: A Unidimensional Measure With Excellent Internal Consistency for Haptic Sensing of Real Objects After Stroke.功能性触觉物体识别测试:一种具有出色内部一致性的单维度测量方法,用于中风后对真实物体的触觉感知。
Front Neurosci. 2020 Sep 23;14:542590. doi: 10.3389/fnins.2020.542590. eCollection 2020.
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Int J Stroke. 2019 Oct;14(8):806-817. doi: 10.1177/1747493019881353.
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Context matters in implementation science: a scoping review of determinant frameworks that describe contextual determinants for implementation outcomes.情境在实施科学中很重要:对描述实施结果情境决定因素的决定因素框架的范围综述。
BMC Health Serv Res. 2019 Mar 25;19(1):189. doi: 10.1186/s12913-019-4015-3.
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The effectiveness of somatosensory retraining for improving sensory function in the arm following stroke: a systematic review.脑卒中后体感再训练改善上肢感觉功能的有效性:系统评价。
Clin Rehabil. 2019 May;33(5):834-846. doi: 10.1177/0269215519829795. Epub 2019 Feb 25.
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Economic burden of stroke: a systematic review on post-stroke care.卒中的经济负担:卒中后护理的系统评价。
Eur J Health Econ. 2019 Feb;20(1):107-134. doi: 10.1007/s10198-018-0984-0. Epub 2018 Jun 16.
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Effects of Somatosensory Impairment on Participation After Stroke.躯体感觉障碍对卒中后参与的影响。
Am J Occup Ther. 2018 May/Jun;72(3):7203205100p1-7203205100p10. doi: 10.5014/ajot.2018.025114.