How is sensation impairment of the upper limb post stroke being assessed within the acute setting?

Introductions to Study

Introduction of Self:

Thank you for your consideration in participating in my research study as part of obtaining my Masters degree in Neurological Rehabilitation in Occupational Therapy at Flinders University. This is my final year of the Masters degree. I am currently employed as a Grade 2 Occupational Therapist, working on the acute Neurosciences Unit at Monash Medical Centre, hence sparking my interest in this subject.

Study Aims:

Sensory impairment in the upper limb is common after stroke negatively impacting overall recovery. Occupational Therapists play an important role in the assessment and treatment of sensory impairment post stroke. At present the assessment of sensation within the acute setting is not well known. Given the importance of early intervention, thorough assessment during acute admission is essential to identify impairment and subsequently tailor appropriate outcome that will lead to improved functional outcomes. Therefore, this study aims to identify the barriers and enablers for the assessment of sensory impairment in patients post stroke within acute care.

Population of interest:

Occupational Therapists who are working in or have previously worked in an acute stroke unit within the past 2 years.

Anticipated Clinical Usefulness of Study:

It is expected that the results of this study will inform the development of a Quality Improvement project to increase the quality of sensory assessment and subsequently improve functional outcomes for patients post stroke.

What’s involved?

Occupational Therapists nationwide are invited to participate in a survey:

https://www.surveymonkey.com/r/V88QNZ5

If you are a Melbourne based therapist, you will also be invited to participate in a focus group. Please email me directly Danielle.byrne@monashhealth.org if you would like the opportunity to participate in focus group to discuss in greater detail this subject.

Time Commitment:

It is anticipated that if you are participating in the on line survey, this will take 10-15 minutes to complete. If you are participating in the focus group you will be required to attend for an hour session.

This project has been approved by Monash Health Human Research Ethics Committee

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* 1. Highest level of education:

Bachelors degree/entry masters degree

Postgraduate diploma/certificate

Postgraduate masters

PhD

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* 2. Years experience with stroke clientele

1-2

3-5

6-10

>10

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* 3. What grade OT are you?

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* 4. What geographical area do you work in?

Metropolitan

Regional

Rural/ Remote

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* 5. Sector

Public

Private

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* 6. How often do you use standardised assessment to assess sensory impairments during acute care?

Always

Usually

Sometimes

Rarely

Never

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* 7. What sensory assessment do you use on the upper limb post stroke?

	Always	Often	Occasionally	Sometimes	Never
Light touch (finger tip/cotton wool)	Light touch (finger tip/cotton wool) Always	Light touch (finger tip/cotton wool) Often	Light touch (finger tip/cotton wool) Occasionally	Light touch (finger tip/cotton wool) Sometimes	Light touch (finger tip/cotton wool) Never
Proprioception/ kinesthesia (limb matching)	Proprioception/ kinesthesia (limb matching) Always	Proprioception/ kinesthesia (limb matching) Often	Proprioception/ kinesthesia (limb matching) Occasionally	Proprioception/ kinesthesia (limb matching) Sometimes	Proprioception/ kinesthesia (limb matching) Never
Pressure (finger tip)	Pressure (finger tip) Always	Pressure (finger tip) Often	Pressure (finger tip) Occasionally	Pressure (finger tip) Sometimes	Pressure (finger tip) Never
Proprioception/ kinesthesia (thumb up/down)	Proprioception/ kinesthesia (thumb up/down) Always	Proprioception/ kinesthesia (thumb up/down) Often	Proprioception/ kinesthesia (thumb up/down) Occasionally	Proprioception/ kinesthesia (thumb up/down) Sometimes	Proprioception/ kinesthesia (thumb up/down) Never
Temperature discrimination (e.g. test tubes)	Temperature discrimination (e.g. test tubes) Always	Temperature discrimination (e.g. test tubes) Often	Temperature discrimination (e.g. test tubes) Occasionally	Temperature discrimination (e.g. test tubes) Sometimes	Temperature discrimination (e.g. test tubes) Never
Point localisation tests	Point localisation tests Always	Point localisation tests Often	Point localisation tests Occasionally	Point localisation tests Sometimes	Point localisation tests Never
Two point discrimination	Two point discrimination Always	Two point discrimination Often	Two point discrimination Occasionally	Two point discrimination Sometimes	Two point discrimination Never
Texture discrimination (3-5 textures)	Texture discrimination (3-5 textures) Always	Texture discrimination (3-5 textures) Often	Texture discrimination (3-5 textures) Occasionally	Texture discrimination (3-5 textures) Sometimes	Texture discrimination (3-5 textures) Never
Vibration	Vibration Always	Vibration Often	Vibration Occasionally	Vibration Sometimes	Vibration Never
Semmes-Weinstein or WEST hand monofilaments	Semmes-Weinstein or WEST hand monofilaments Always	Semmes-Weinstein or WEST hand monofilaments Often	Semmes-Weinstein or WEST hand monofilaments Occasionally	Semmes-Weinstein or WEST hand monofilaments Sometimes	Semmes-Weinstein or WEST hand monofilaments Never
Tactile Discrimination Test	Tactile Discrimination Test Always	Tactile Discrimination Test Often	Tactile Discrimination Test Occasionally	Tactile Discrimination Test Sometimes	Tactile Discrimination Test Never
Rivermead Assessment of Somatosensory Performance	Rivermead Assessment of Somatosensory Performance Always	Rivermead Assessment of Somatosensory Performance Often	Rivermead Assessment of Somatosensory Performance Occasionally	Rivermead Assessment of Somatosensory Performance Sometimes	Rivermead Assessment of Somatosensory Performance Never
Nottingham Sensory Assessment	Nottingham Sensory Assessment Always	Nottingham Sensory Assessment Often	Nottingham Sensory Assessment Occasionally	Nottingham Sensory Assessment Sometimes	Nottingham Sensory Assessment Never
Wrist Positional Test	Wrist Positional Test Always	Wrist Positional Test Often	Wrist Positional Test Occasionally	Wrist Positional Test Sometimes	Wrist Positional Test Never
Functional Tactile Object Recognition Test	Functional Tactile Object Recognition Test Always	Functional Tactile Object Recognition Test Often	Functional Tactile Object Recognition Test Occasionally	Functional Tactile Object Recognition Test Sometimes	Functional Tactile Object Recognition Test Never
Manual Form Perception Test	Manual Form Perception Test Always	Manual Form Perception Test Often	Manual Form Perception Test Occasionally	Manual Form Perception Test Sometimes	Manual Form Perception Test Never
No specific approaches	No specific approaches Always	No specific approaches Often	No specific approaches Occasionally	No specific approaches Sometimes	No specific approaches Never

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* 8. How strongly do you agree or disagree about the following statements:

	Strongly agree	Somewhat agree	Neutral/Unsure	Somewhat disagree	Strongly disagree
I am lacking in knowledge of assessing for sensory impairment	I am lacking in knowledge of assessing for sensory impairment Strongly agree	I am lacking in knowledge of assessing for sensory impairment Somewhat agree	I am lacking in knowledge of assessing for sensory impairment Neutral/Unsure	I am lacking in knowledge of assessing for sensory impairment Somewhat disagree	I am lacking in knowledge of assessing for sensory impairment Strongly disagree
There is no evidence to support sensory assessment post stroke	There is no evidence to support sensory assessment post stroke Strongly agree	There is no evidence to support sensory assessment post stroke Somewhat agree	There is no evidence to support sensory assessment post stroke Neutral/Unsure	There is no evidence to support sensory assessment post stroke Somewhat disagree	There is no evidence to support sensory assessment post stroke Strongly disagree
Assessment of sensation in the upper limb is not a priority in the acute setting	Assessment of sensation in the upper limb is not a priority in the acute setting Strongly agree	Assessment of sensation in the upper limb is not a priority in the acute setting Somewhat agree	Assessment of sensation in the upper limb is not a priority in the acute setting Neutral/Unsure	Assessment of sensation in the upper limb is not a priority in the acute setting Somewhat disagree	Assessment of sensation in the upper limb is not a priority in the acute setting Strongly disagree
Somatosensory assessment is not part of my role	Somatosensory assessment is not part of my role Strongly agree	Somatosensory assessment is not part of my role Somewhat agree	Somatosensory assessment is not part of my role Neutral/Unsure	Somatosensory assessment is not part of my role Somewhat disagree	Somatosensory assessment is not part of my role Strongly disagree
It is too early to commence sensory rehabilitation in the acute setting	It is too early to commence sensory rehabilitation in the acute setting Strongly agree	It is too early to commence sensory rehabilitation in the acute setting Somewhat agree	It is too early to commence sensory rehabilitation in the acute setting Neutral/Unsure	It is too early to commence sensory rehabilitation in the acute setting Somewhat disagree	It is too early to commence sensory rehabilitation in the acute setting Strongly disagree
Time limitations prevent me from completing a standardised assessment of somatosensory impairment	Time limitations prevent me from completing a standardised assessment of somatosensory impairment Strongly agree	Time limitations prevent me from completing a standardised assessment of somatosensory impairment Somewhat agree	Time limitations prevent me from completing a standardised assessment of somatosensory impairment Neutral/Unsure	Time limitations prevent me from completing a standardised assessment of somatosensory impairment Somewhat disagree	Time limitations prevent me from completing a standardised assessment of somatosensory impairment Strongly disagree

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* 9. How would you rate your confidence in recommending and prescribing sensory rehab interventions in the acute setting?

0-not at all confident

5-somewhat confident

10-very confident

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 10. Is there anything else, not already identified in the questionnaire as to what you as an acute therapist, are doing to screen for somatosensory impairment in the upper limb?

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* 1. Highest ﻿level of education:

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* 2. Years experience with stroke clientele

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* 3. What grade OT are you?

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* 4. What geographical area do you work in?

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* 5. Sector

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* 6. How often do you use standardised assessment to assess sensory impairments during acute care?

Question Title

* 7. What sensory assessment do you use on the upper limb post stroke?

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* 8. How strongly do you agree or disagree about the following statements:

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* 9. How would you rate your confidence in recommending and prescribing sensory rehab interventions in the acute setting?

Question Title

* 10. Is there anything else, not already identified in the questionnaire as to what you as an acute therapist, are doing to screen for somatosensory impairment in the upper limb?

* 1. Highest level of education: