Unlocking the restraint-Development of a behaviour change intervention to increase the provision of modified constraint-induced movement therapy in stroke rehabilitation

Ashan Weerakkody; Robyn Emmanuel; Jocelyn White; Erin Godecke; Barby Singer

doi:10.1111/1440-1630.12896

Unlocking the restraint-Development of a behaviour change intervention to increase the provision of modified constraint-induced movement therapy in stroke rehabilitation

Aust Occup Ther J. 2023 Dec;70(6):661-677. doi: 10.1111/1440-1630.12896. Epub 2023 Jul 9.

Authors

Ashan Weerakkody^{1

2}, Robyn Emmanuel^{1

3}, Jocelyn White¹, Erin Godecke^{2

4}, Barby Singer^{2

5}

Affiliations

¹ Rehabilitation in the Home, South Metropolitan Health Service, Department of Health, Fremantle, Australia.
² School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
³ Neurotherapy Occupational Therapy Services, Perth, Australia.
⁴ Sir Charles Gairdner Hospital, North Metropolitan Health Service, Department of Health, Nedlands, Australia.
⁵ TRAining Centre in Subacute Care (TRACSWA), Department of Health, Fremantle, Australia.

PMID: 37424149
DOI: 10.1111/1440-1630.12896

Abstract

Background: Strong evidence supports the provision of modified constraint-induced movement therapy (mCIMT) to improve upper limb function after stroke. A service audit identified that very few patients received mCIMT in a large subacute, early-supported discharge rehabilitation service. A behaviour change intervention was developed to increase the provision of mCIMT following an unsuccessful 'education only' attempt. This paper aims to systematically document the steps undertaken and to provide practical guidance to clinicians and rehabilitation services to implement this complex, yet effective, rehabilitation intervention.

Methods: This clinician behaviour change intervention was developed over five stages and led by a working group of neurological experts (n = 3). Data collection methods included informal discussions with clinicians and an online survey (n = 35). The staged process included reflection on why the first attempt did not improve the provision of mCIMT (stage 1), mapping barriers and enablers to the Theoretical Domains Framework (TDF) and behaviour change wheel (BCW) to guide the behaviour change techniques (stages 2 and 3), developing a suitable mCIMT protocol (stage 4), and delivering the behaviour change intervention (stage 5).

Results: Reflection among the working group identified the need for upskilling in mCIMT delivery and the use of a behaviour change framework to guide the implementation program. Key determinants of behaviour change operated within the TDF domains of knowledge, skills, environmental context and resources, social role and identity, and social influences. Following the development of a context-specific mCIMT protocol, the BCW guided the behaviour change intervention, which included education, training, persuasion, environmental restructuring, and modelling.

Conclusion: This paper provides an example of using the TDF and BCW to support the implementation of mCIMT in a large early-supported discharge service. It outlines the suite of behaviour change techniques used to influence clinician behaviour. The success of this behaviour change intervention will be explored in future research.

Keywords: implementation science; knowledge translation; neurological rehabilitation; occupational therapy; physiotherapy; upper extremity.

MeSH terms

Humans
Occupational Therapy*
Physical Therapy Modalities
Stroke Rehabilitation* / methods
Stroke*
Upper Extremity