SENSe Implement: changing clinical practice in sensory rehabilitation of the arm after stroke.

Abstract

BACKGROUND: Strong evidence exists for the remediation of upper-limb sensory loss and a specific evidence-based approach is recommended in stroke clinical practice guidelines. Despite this, stroke survivors are not currently receiving this treatment. A structured approach is required to translate published research into rehabilitation practices. The SENSe Implement study will determine whether evidence-based research translation strategies can change work practices and behaviours of occupational therapists (OTs) and physiotherapists (PTs) in stroke rehabilitation. Our first aim is to identify site-specific barriers and enablers to OTs' and PTs' use of clinical practice guidelines for rehabilitation of post-stroke upper-limb sensory loss. METHOD: We developed a 'knowledge-transfer' intervention to drive behaviour change in clinical settings. The intervention is guided by Theoretical Domains Framework, with translation strategies from the Behaviour Change Wheel. An interview schedule was developed to determine site-specific barriers and enablers. Participating OTS and PTs (n=62) completed pre-implementation questionnaires and focus group interviews. Multi-faceted translation strategies including: tailoring of the implementation intervention to site-specific barriers and enablers; interactive group training workshop; champion therapists; and provision of educational materials have been introduced in five Australian health organisations. RESULTS: Barriers and incentives for achieving evidence-based practice have been identified. Analysis of pre-implementation data from therapists reveals several emerging themes: The Desire for Best Practice; The Uncertain Therapist; The Importance of Getting it Right. CONCLUSION: Evidence-based strategies and frameworks are important to facilitate implementation of science-based rehabilitation. Implementation interventions should be tailored to site-specific barriers and enablers.