Increasing the delivery of upper limb constraint-induced movement therapy post-stroke: A feasibility implementation study

Annie McCluskey; Louise Massie; Gillian Gibson; Lisa Pinkerton; Ana Vandenberg

doi:10.1111/1440-1630.12647

Increasing the delivery of upper limb constraint-induced movement therapy post-stroke: A feasibility implementation study

Aust Occup Ther J. 2020 Jun;67(3):237-249. doi: 10.1111/1440-1630.12647. Epub 2020 Feb 18.

Authors

Annie McCluskey^{1

2}, Louise Massie^{3

4}, Gillian Gibson^{5

6}, Lisa Pinkerton^{5

7}, Ana Vandenberg⁸

Affiliations

¹ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, NSW, Australia.
² The StrokeEd Collaboration, Sydney, NSW, Australia.
³ Community Rehab Northern Queensland, Townsville-Mackay Medicare Local, Townsville, Qld, Australia.
⁴ Maclean District Hospital, Maclean, NSW, Australia.
⁵ Stroke Outreach Service, Sydney Local Health District, Camperdown, NSW, Australia.
⁶ Balmain Hospital, Sydney Local Health District, Balmain, NSW, Australia.
⁷ The Wollongong Hospital, Wollongong, NSW, Australia.
⁸ Launceston General Hospital, Launceston, Tas, Australia.

PMID: 32072656
DOI: 10.1111/1440-1630.12647

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: knowledge translation; occupational therapy; physiotherapy.

MeSH terms

Aged
Clinical Competence
Feasibility Studies
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Occupational Therapy / methods*
Occupational Therapy / standards
Stroke Rehabilitation / methods*
Stroke Rehabilitation / standards
Upper Extremity / physiopathology*