Current therapy for the upper limb after stroke: a cross-sectional survey of UK therapists

Abstract

ObjectivesTo survey the reported content, frequency and duration of upper limb treatment provided by occupational and physiotherapists for people after stroke in the UK.DesignA cross-sectional online survey was used. Description and analysis of the data were based on items from the Template for Intervention Description and Replication (Who, Where, What and How much).SettingThe online survey was distributed via professional and social networks to UK-based therapists.ParticipantsRespondents were occupational or physiotherapists currently working clinically in the UK with people after stroke. Over the 6 week data collection period, 156 respondents opened the survey, and 154 completed it. Respondents comprised 85 physiotherapists and 69 occupational therapists.ResultsRespondents reported treating the upper limb a median of three times a week (range: 1 to 7) for a mean of 29 min (SD: 18). Most (n=110) stated this was supplemented by rehabilitation assistants, family and/or carers providing additional therapy a median of three times a week (range 1 to 7). Functional training was the most commonly reported treatment for people with mild and moderate upper limb deficits (>40%). There was much less consistency in treatments reported for people with severe upper limb deficits with less than 20% (n=28) reporting the same treatments.ConclusionsThis study provides a contemporaneous description of reported therapy in the UK for people with upper limb deficits after stroke and a detailed template to inform standard therapy interventions in future research. Several evidence-based therapies were reported to be used by respondents (eg, constraint induced movement therapy), but others were not (eg, mental imagery). The findings also highlight that the current reported provision of upper limb therapy is markedly less than what is likely to be effective. This underlines an urgent need to configure and fund services to empower therapists to deliver greater amounts of evidence-based treatment for people with upper limb deficits after stroke.

Can the early use of botulinum toxin in post stroke spasticity reduce contracture development? A randomised controlled trial

“…The most likely reason for a failure to demonstrate functional benefit was that many of our patients may have had severe strokes with a lower potential for recovery 24 and a paucity in the access to an appropriate intensity/dose of rehabilitation for the upper limb. 25 It was, however, reassuring that the early treatment of spasticity with botulinum toxin appears not to have interfered with the recovery of arm function in those who are likely to have had the potential for functional recovery.…”

To stimulate or not to stimulate? A rapid systematic review of repetitive sensory stimulation for the upper-limb following stroke

“…It should also be noted that several studies used RSS with other treatments considered to be usual care or therapy (e.g. motor training) [23], whilst others did not. Combining RSS with targeted motor training could enhance overall benefit by a "priming" effect of RSS upon cortical plasticity which can then be utilized by motor training [11].…”

“…For the purposes of this review ESS, RPSS, PNS and PSS were considered to be RSS but the different parameters of delivering RSS were described to elucidate any superiority. Studies where the effects of RSS alone or as an adjunct to usual care/therapy [23] could not be determined, and those using mixed populations/etiologies unless stroke was included and discussed separately, were excluded. Interventions that included functional electrical stimulation, neuromuscular stimulation (e.g.…”

Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT

“…In terms of dose, upper limb therapy was reportedly provided for an average of 29 minutes, three times per week. 118 However, this amount exceeds that of observational studies of upper limb treatment. 76,111,119 Recording, measuring and monitoring the treatment received by individuals, and reporting of the rehabilitation services provided, should be integral to routine clinical practice and should not be seen as an added burden.…”

“…This finding resonates to some extent with findings from a recent survey of upper limb treatment reported by physiotherapists and occupational therapists across the UK. 118 This survey reported that, although there was considerable variation in treatments provided for stroke patients with severe upper limb deficits, the most common were range of movement exercises, mirror-box therapy and functional electrical stimulation. For those with less severe upper limb deficit, most interventions comprised active, task-specific practice.…”