Increasing the delivery of upper limb constraint-induced movement therapy post-stroke: A feasibility implementation study.
knowledge translation
occupational therapy
physiotherapy
Journal
Australian occupational therapy journal
ISSN: 1440-1630
Titre abrégé: Aust Occup Ther J
Pays: Australia
ID NLM: 15420200R
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
04
03
2019
revised:
03
12
2019
accepted:
11
01
2020
pubmed:
20
2
2020
medline:
30
6
2021
entrez:
20
2
2020
Statut:
ppublish
Résumé
Few stroke survivors receive upper limb constraint-induced movement therapy (CIMT). The aims of this study were to evaluate whether a behaviour change program for occupational therapists increased the number of stroke survivors receiving CIMT, describe the time and process involved in delivering the first program, any adverse events, fidelity and dose of CIMT provided, and upper limb outcomes. A feasibility pre-post implementation study design was used, with intervention and measures for therapists and stroke survivors. Intervention for occupational therapists was informed by the Behaviour Change Wheel and included CIMT training, barrier identification, mentoring and a community of practice. Therapists delivered 2-week CIMT programs with 1:1 supervision, first assisting stroke survivors to identify upper limb goals using the Canadian Occupational Performance Measure. The primary outcome was change in the number of stroke survivors receiving CIMT (program reach). Hours associated with program delivery, adverse events and participant repetitions were recorded (program fidelity and dose). Change in motor function was measured (fidelity) using the Motor Assessment Scale (Upper Limb), Box and Block Test, Nine Hole Peg Test and Motor Activity Log at baseline, program completion (2 weeks), 1 and 12 months. Program reach: Sixteen stroke participants were recruited (mean 15.3 months post-stroke, SD 11.9) and six CIMT programs conducted over 24 months, compared to none pre-implementation. The first CIMT program required a mean of 242 hours for preparation and delivery. All programs were student-assisted. Fidelity and dose: Stroke participants completed a mean of 360.6 repetitions/hour (SD 183.7), and 12,719.6 repetitions/program (SD 6,872.8). Statistically significant changes in upper limb motor function were recorded; some changes were clinically important. The behaviour change program resulted in multiple CIMT programs being delivered safely and with fidelity. Capacity building and skill development took many hours, as did preparation for the first CIMT program.
Identifiants
pubmed: 32072656
doi: 10.1111/1440-1630.12647
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
237-249Informations de copyright
© 2020 Occupational Therapy Australia.
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