Feasibility and effect of a professional education workshop for occupational therapists' management of upper-limb poststroke sensory impairment.

OBJECTIVE: We examined the development, implementation, and effectiveness of a theory-based workshop to facilitate knowledge translation for occupational therapists addressing upper-limb poststroke sensory impairments. METHOD: Nineteen therapists participated in a quasi-experimental pretest-posttest study that included an 8-hr evidence-based workshop designed using the Theory of Planned Behavior. We measured changes in knowledge, attitudes, and perceived behavioral control and intended behaviors regarding sensory impairment management, research utilization, and shared decision making. RESULTS: We noted significant changes in knowledge, attitudes, and perceived behavioral control and intended behaviors about sensory impairment management, research utilization, and shared decision making and made recommendations for changes in recruitment strategies, outcome measures, and workshop content. CONCLUSION: A theory-based workshop can potentially affect knowledge, attitudes, and intended behaviors about sensory impairment management, research utilization, and shared decision making. A randomized controlled trial evaluating this intervention is warranted and will potentially improve understanding of methods to facilitate knowledge translation.

Upper limb post-stroke sensory impairments: the survivor's experience.

PURPOSE: This study described stroke survivors' experiences of upper limb post-stroke sensory impairment (ULPSSI) and its rehabilitation. METHODS: A qualitative descriptive study of 15 stroke survivors with ULPSSI using semi-structured interviews. A focus group of eight survivors reviewed thematic outcomes. Analysis was completed by three authors. RESULTS: Three themes emerged: (1) What happened to my hand?: A description of the significant impact of sensory impairments on survivors roles and participation; (2) I was only just getting started: Survivors felt sensory impairments and the upper limb were ignored in rehabilitation and described being left on their own to devise their own rehabilitation; and (3) If I work hard then maybe someday: Survivors felt sensory impairments recovered slowly and was aided by working towards recovery and maintaining hope. CONCLUSIONS: Sensory impairments are significant for survivors and are deserving of greater clinical and research attention. In particular, assessments and interventions need further development and testing. This study's findings revealed the need to ascertain individual survivors' preference for involvement in decision making related to their rehabilitation planning. It also found survivors view recovery as extending well beyond current rehabilitation frameworks, necessitating further description of recovery and re-evaluation of service delivery to address survivors' needs. IMPLICATIONS FOR REHABILITATION: Sensory impairments significantly impact stroke survivors' roles and participation. Remediation of sensory impairments is important to survivors, but seems to be ignored in the rehabilitation process. Individual survivors' preference for involvement in decision making related to their rehabilitation planning should be ascertained. Stroke survivors feel left on their own to address their upper limb impairments long after rehabilitation services have ended. The development of services beyond the normal rehabilitation timeframes is warranted.

Sensory impairment after stroke: Exploring therapists' clinical decision making

BACKGROUND: Stroke survivors experience sensory impairments that significantly limit upper-limb functional use. Lack of clear research-based guidelines about their management exacerbates the uncertainty in occupational therapists' decision making to support these clients. PURPOSE: This study explores occupational therapists' clinical decision making regarding upper-limb, post-stroke sensory impairments that can ultimately inform approaches to support therapists working with such clients. METHOD: Twelve therapists participated in a qualitative descriptive study. Transcripts of semi-structured interviews were analyzed using content analysis. FINDINGS: Three overarching categories were identified: deciding on the focus of interventions (describing intervention choices), it all depends (outlining factors considered when choosing interventions), and managing uncertainty in decision making (describing uncertainty and actions taken to resolve it). IMPLICATIONS: Providing training about post-stroke sensory impairment and decision making may improve therapists' decision making and ultimately improve client outcomes. Further research is needed to understand the impact of uncertainty on occupational therapy decision making and resulting care practices.