The University of Sydney 2. Liverpool Brain Injury Rehabilitation Unit

Transcription

1 Successful Implementation of Constraint Induced Movement Therapy (CIMT): An International qualitative study Lauren Christie 1,2,3 Annie McCluskey 1 & Meryl Lovarini 1 1 The University of Sydney 2 Liverpool Brain Injury Rehabilitation Unit 3 Brain Injury Rehabilitation Research Group, The Ingham Institute for Applied Medical Research The University of Sydney Page 1

2 Rationale 1. Intensive graded exercise program using the affected arm 2. Constraint of the non-affected arm to promote use of the affected arm 3. A transfer package to support transfer of new skills into real life 1. Kwakkel, G. et al. (2015). Lancet Neurology. 2. All photos courtesy of Google images The University of Sydney Page 2

3 Aim To identify enablers to implementation and sustainable delivery of constraint induced movement therapy (CIMT) programs internationally. 1. Intensive graded exercise program using the affected arm 2. Constraint of the non-affected arm to promote use of the affected arm 3. A transfer package to support transfer of new skills into real life The University of Sydney Page 3

4 Methods The University of Sydney Page 4

5 14 Domains of the Theoretical Domains Framework (TDF) Skills Social influences Env context & resources Knowledge Reinforcement Goals Memory/ attention Intentions Behavioural regulation Have there been any challenges related to resources to implementing CIMT in your workplace? What were these challenges and how did you overcome them? Beliefs about consequence s Role and identity Beliefs about capabilities Optimism Emotion The University of Sydney Page 5 Michie et al (2005); Cane et al (2012)

6 Preliminary results (n=8) Skills Social influences Env context & resources Knowledge Reinforcement Goals INT 3: 2: 4: I had think worked we've got with the neuro support patients from for both years I and colleagues, think years what but so helped truly it's accepted I was had freedom never from seen the to change colleagues act. like I think and I've that's seen also from with the biggest these our leaders. patients thing So that I the think stops full that's people protocol very setting of what something we important, do has up such the from support, an impact. scratch. that You we In a have know, statutory been if I've able not service to Behavioural you seen run it are changes over already these I'm regulation years doing questioning stuff and what's so.in going order on to fit something new in that's got a Role massive and because I expect change. evidence base, identity what you almost have to do is stop doing something. So INT in 4: order I see to the think, results, well I these think most upper Beliefs of limb the about patients interventions are satisfied after aren't these working, two weeks, I'm going and capabilities to that's stop.and motivating in I'm itself going I think. to do CIMT, it requires not only an understanding of why you're doing Optimism it but an understanding of why that has got more added value than that. So I would suggest that the biggest Emotion enabler of us setting up CIMT has been my ability to Beliefs about clinically say this is what consequence we're going to do and I've Intentions got freedom to act. s Memory/ attention The University of Sydney Page 6 Michie et al (2005); Cane et al (2012)

7 Discussion/ Clinical Implications Key enablers to successful CIMT implementation include: - Therapist knowledge and skills developed through training - Social influences including organisational support - Environmental context and resources Importance of reinforcement through positive patient outcomes Seeing is believing The University of Sydney Page 7

8 Conclusion Successful implementation of CIMT in practice is multifaceted The emerging findings have been used to inform the development of an implementation package for a CIMT translational research project in South Western Sydney, The ACTIveARM project The University of Sydney Page 8

9 Contact details Lauren Christie Inpatient Program Coordinator & Health Professional Educator Liverpool Brain Injury Rehabilitation Unit Ph: (02) The University of Sydney Page 9

10 Key references 1. Kwakkel, G., Veerbeek, JM., van Wagen, EEH., Wolf, SL. (2015). Constraint-induced movement therapy after stroke. Lancet Neurology; 14: Walker, J., Pink, MJ (2009). Occupational therapists and the use of constraintinduced movement therapy in neurological practice. Australian Occupational Therapy Journal; 56: Viana, R., Teasell, R. (2012). Barriers to the Implementation of Constraint-Induced Movement Therapy Into Practice. Top Stroke Rehabilitation, 19(2), Fleet A, Che M, MacKay-Lyons M, MacKenzie D, Page S, Eskes G, McDonald A, Boyce J, & Boe S. (2014). Examining the use of constraint-induced movement therapy in Canadian neurological occupational and physical therapy. Physiotherapy Canada, 66(1), Cane J et al. (2012).Validation of the Theoretical Domains Framework for use in behaviour change and implementation research. Implementation Science, 7:37. The University of Sydney Page 10