Search

Objectives: Somatosensory loss is common after stroke with one-in-two individuals affected. Although clinical practice guidelines recommend providing somatosensory rehabilitation, this impairment often remains unassessed and untreated. To address the gap between guideline recommendations and clinical practice, this study sought to understand the factors influencing delivery of evidence-based upper limb sensory rehabilitation after stroke., Design: Qualitative study involving focus groups and interviews. Data analysis used an inductive approach (thematic analysis) and deductive analysis using implementation theory (the Theoretical Domains Framework and Normalisation Process Theory)., Setting: Eight healthcare organisations in metropolitan and regional areas of Victoria and New South Wales, Australia., Participants: Eighty-seven rehabilitation therapists (79% occupational therapists and 21% physiotherapists) were purposively sampled and participated in a knowledge translation study with staggered recruitment from 2014 to 2018., Results: Three types of factors influenced therapists' delivery of upper limb somatosensory rehabilitation: individual ('The uncertain, unskilled therapist'), patient ('Patient understanding and priorities ' ) and organisational ('System pressures and resources ' ). Deductive analysis using implementation theory identified key determinants of practice change, such as opportunities to consolidate new skills, the anticipated benefits of upskilling as a therapy team and the work anticipated by therapists to incorporate a new somatosensory rehabilitation approach., Conclusions: Occupational therapists and physiotherapists hold valuable insights towards practice change in somatosensory rehabilitation from the 'frontline'. Therapists experience barriers to change including a lack of knowledge and skills, lack of resources and organisational pressures. Facilitators for change were identified, including social support and therapists' perceived legitimacy in using new somatosensory rehabilitation approaches. Results will inform the design of a tailored implementation strategy to increase the use of evidence-based somatosensory rehabilitation in Australia., Trial Registration Number: Australian New Zealand Clinical Trials Registry (ACTRN12615000933550)., Competing Interests: Competing interests: LMC is the lead author of the SENSe approach to sensory rehabilitation, the focus of knowledge translation in the SENSe Implement project. A SENSe training package (manual and DVD) has been developed and is available for purchase from a Not for Profit organisation. SENSe assessment and training equipment are also available for purchase. LMC has no personal financial interest in the sale of these resources. There is no patent, or intended application for a patent, associated with these resources. LMC has conducted workshops on the SENSe approach and been invited to give lectures and conference presentations on the approach., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)