Sensory relearning in peripheral nerve disorders of the hand: a web-based survey and delphi consensus method.

UNLABELLED: Sensory relearning (SR) first described in the 1970s by Wynn-Parry and Dellon has evolved over the last 20 years as a result of new insights into cortical plasticity. It has eluded precise definition, and a detailed description of its "key ingredients" is rarely documented in published studies investigating effectiveness. The purpose of this two-part study was to define SR and describe the content of an SR program in the treatment of peripheral nerve disorders of the hand. The first part included a review of current published evidence and a survey of clinical practice. The second part comprised a Delphi method to develop consensus on the definition and indicative content of an SR program with a view to evaluating its clinical effectiveness in future trials. The Web-based survey of SR practices among European hand therapists was undertaken first. A total of 70 respondents returned their questionnaires representing 10 European-member countries. Frequencies and percentages were used to summarize the responses. The results confirmed that both classical and novel techniques for SR are being used by hand therapists. Classical methods, such as retraining of tactile gnosis through graded textures, shapes, and objects, were more frequently used than newer methods, such as mirrors or sensory substitution, which have been advocated as part of early-phase retraining and were developed in the last 10 years. An internet-mediated Delphi method with seven experts from four European countries yielded consensus on a definition of SR and its indicative content. Further work is needed to ensure that this can be translated into feasible treatment programs that can be evaluated in future trials. LEVEL OF EVIDENCE: IV, Consensus study.