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Factors influencing allied health professionals' implementation of upper limb sensory rehabilitation for stroke survivors: A qualitative study to inform knowledge translation

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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).

Funding

We acknowledge support for conduct of the research from the National Health and Medical Research Council (NHMRC) of Australia partnership grant: A network of sites and `up-skilled' therapists to deliver best practice stroke rehabilitation of the upper limb (GNT 1134495) and NHMRC Ideas grant (GNT 2004443). LSC was supported by an Australian Government Research Training Programme Scholarship. NAL was supported by a Future Leader Fellowship (102055) from the National Heart Foundation of Australia. DAO is supported by a NHMRC Translating Research into Practice Fellowship (GNT 1168749).

History

Publication Date

19/02/2021

Journal

BMJ Open

Volume

11

Issue

2

Article Number

e042879

Pagination

11p.

Publisher

BMJ PUBLISHING GROUP

ISSN

2044-6055

Rights Statement

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