What is “usual care” in the rehabilitation of upper limb sensory loss after stroke? Results from a national audit and knowledge translation study

Purpose
To characterise the assessments and treatments that comprise “usual care” for stroke patients with somatosensory loss, and whether usual care has changed over time.

Materials and methods
Comparison of cross-sectional, observational data from (1) Stroke Foundation National Audit of Acute (2007–2019) and Rehabilitation (2010–2018) Stroke Services and (2) the SENSe Implement multi-site knowledge translation study with occupational therapists and physiotherapists (n = 115). Descriptive statistics, random effects logistic regression, and content analysis were used.

Results
Acute hospitals (n = 172) contributed 24 996 cases across audits from 2007 to 2019 (median patient age 76 years, 54% male). Rehabilitation services (n = 134) contributed organisational survey data from 2010 to 2014, with 7165 cases (median 76 years, 55% male) across 2016–2018 clinical audits (n = 127 services). Somatoensory assessment protocol use increased from 53% (2007) to 86% (2019) (odds ratio 11.4, 95% CI 5.0–25.6). Reported use of sensory-specific retraining remained stable over time (90–93%). Therapist practice reports for n = 86 patients with somatosensory loss revealed 16% did not receive somatosensory rehabilitation. The most common treatment approaches were sensory rehabilitation using everyday activities (69%), sensory re-education (68%), and compensatory strategies (64%).

Conclusion
Sensory assessment protocol use has increased over time while sensory-specific training has remained stable. Sensory rehabilitation in the context of everyday activities is a common treatment approach. Clinical trial registration number: ACTRN12615000933550

IMPLICATIONS FOR REHABILITATION
• Only a small proportion of upper limb assessments conducted with stroke patients focus specifically on sensation; increased use of standardised upper limb assessments for sensory loss is needed.

• Stroke patients assessed as having upper limb sensory loss frequently do not receive treatment for their deficits.

• Therapists typically use everyday activities to treat upper limb sensory loss and may require upskilling in sensory-specific retraining to benefit patients.