A qualitative exploration of occupational therapy practices in addressing post-stroke somatosensory impairments in Malta

Abstract

Background: Post-stroke somatosensory impairments can significantly influence motor function and engagement in meaningful occupations (Carey et al., 2018). Despite their clinical importance, they are frequently under-recognised and inconsistently addressed in rehabilitation (Byrne et al., 2023). This may contribute to reduced participation outcomes amongst stroke survivors, highlighting the need to better understand how they are addressed in OT practice (Pumpa et al., 2015). Aim: This study aimed to explore occupational therapists’ perspectives on the impact of somatosensory impairments. It further aimed to explore current clinical practices, identify potential barriers to somatosensory rehabilitation and gather recommendations to further support its integration within clinical practice. Method: A qualitative research design was adopted. Eight occupational therapists working within stroke settings were recruited through purposive sampling. Data was gathered through semi-structured interviews and later analysed using Braun & Clarke’s (2006) thematic analysis. Findings: Five main themes were identified: “Motor, Functional and Psychological Impact”, “Assessment of Somatosensory Impairments in Clinical Practice”, “Intervention Approaches, Clinical Reasoning and Perceived Effectiveness”, “Barriers to Somatosensory Assessment and Rehabilitation” and “Recommendations for Strengthening Somatosensory Rehabilitation Practice.” Within these themes, therapists described the significant impact of somatosensory impairments on stroke survivors’ motor function, occupational performance, safety and emotional wellbeing. In clinical practice, somatosensory assessment was recognised as an integral part of routine OT evaluation, however it was conducted using informal methods. Intervention approaches were varied and guided by clinical reasoning, but their effectiveness was perceived to be inconsistent. Discussion: Therapists recognised the importance of addressing somatosensory impairments however practice was shaped by interrelated barriers, including time constraints, limited resources, reduced training opportunities and limited patient awareness. As a result, therapists emphasised the need to strengthen somatosensory rehabilitation within practice through greater organisational investment in standardised assessment tools, increased resource availability, ongoing professional development and patient education. Strengthening these areas may support effective integration of somatosensory rehabilitation within clinical practice, contributing to improved occupational performance, greater participation and enhanced quality of life among stroke survivors.