Edelstyn, N

Hunter, S

Jarvis, K

Reid, G

University of Liverpool Repository

Therapists’ perceptions of implementing constraint induced movement therapy: the enablers and barriersJarvis KA,a,b Edelstyn NMJ,a,c Reid GA,b Hunter SMd,ea. Research Institute for Social Sciences, Keele University; b. Directorate of Occupational Therapy, University of Liverpool; c. School of Psychology, Keele University; d. School of Health and Rehabilitation, Keele University; e. Institute for Science and Technology in Medicine (ISTM), Keele UniversityBackgroundConstraint induced movement therapy (CIMT) aims to increase function in the arm and hand following stroke and has been described as a collection of techniques thatinclude two fundamental elements: 1. constraint or reduction of use of the ipsilesional (less affected) arm and hand; 2. intense re-training of the contralesional (moreaffected) arm and hand1. Whilst evidence suggests that constraint induced movement therapy (CIMT) is effective in reducing disability1, therapists are not implementingevidence-based CIMT protocols2. The reasons for this are unclear.FindingsProtocols with shorter intensity of daily training time and shorter constraint times were perceived as more feasible; overall length (duration) of the protocol was considered less important.Analyses of the data led to the emergence of 6 themes. These are presented in Figure 1 with the key enablers and barriers.MethodFurther information:Kathryn Jarvis k.jarvis@liv.ac.uk 0151 794 5721ConclusionsTherapists made decisions about feasibility of CIMT based on their current service constraints. Evidence-based protocols that required changes to service structure or additional funding were not seen as feasible for stroke service users. If CIMT is to be implemented successfully, enablers and barriers identified in this study should be addressed.References1. Sirtori, V., et al. Constraint-induced Movement  Therapy for upper extremities in stroke patients.  Cochrane Database of Systematic Reviews, 2009. DOI:10.1002/14651858.CD004433.pub2.2. Jarvis, K., et al. Occupational Therapy stroke Arm and Hand Record (OT-STAR): Development of an upper limb treatment schedule for occupational therapists working with stroke survivors, 2012; in preparation.Implementing CIMTEnablers & BarriersThe CIMT InterventionBig blocks of training are difficult to provideWorking with one person for an intense period may bring challengesProtocols over 7 days not possibleEthical ConsiderationsNeed for risk assessmentPotential decreased independence and increased need for assistance while undertaking CIMTEducation & TrainingCurrent lack of knowledge and experience using CIMTTraining should include formal training and practical sessions within therapy teamA CIMT Mentor could help problem-solveStroke Survivor CharacteristicsThe following may impact on ability to undertake CIMT:-Motivation-Mood-Cognition-Concentration-Activity in arm and handSetting & SupportFormal carers unable to offer necessary supportAdditional time required in everyday activities due to restraintGood communication necessary between all parties involved PracticalitiesResources such as list of activities and checklists requiredConsideration of staff mixFigure 1 The emergent themesRecruitmentWith ethical approval, all occupational therapists and physiotherapists experienced in stroke rehabilitation from a North West England Hospital Trust were invited to participate.Data CollectionEach participant: -Completed a questionnaire recording professional background, grade and length of time working with stroke survivors.-Participated in an audio-recorded focus group, underpinned by a social constructionist approach.During the focus group:• Evidence-based CIMT protocols for sub-acute stroke were presented• Participants considered the needs of stroke survivors, themselves and their employing organisation in relation to implementing CIMTData AnalysesRecorded qualitative data was transcribed verbatim and analysed by two independent researchers  using an inductive thematic analysis. Emergent themes were discussed and differences agreed through consensus. Themes were organised to answer the research questions. Reflexive documentation recorded decisions and provided an audit trail.The 6 hours would go over a whole morning and into an afternoon…[this protocol] looks the most difficult to incorporateThe  5 hours restraint might be something the patient can do themselves with supervision at homeResearch QuestionsWhich evidence-based CIMT protocols do therapists perceive could be provided within a UK stroke service?What are therapists’ perceived enablers and barriers to implementing the identified CIMT protocols?Acknowledgements:We would like to thank the therapists who participated in this study and The Constance Owens Fund for financial support

Therapists' perceptions of implementing constraint induced movement therapy: the enablers and barriers

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