Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, NSW, Australia.
The StrokeEd Collaboration, Sydney, NSW, Australia.
Aust Occup Ther J. 2020 Jun;67(3):237-249. doi: 10.1111/1440-1630.12647. Epub 2020 Feb 18.
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.
很少有中风幸存者接受上肢强制性运动疗法（CIMT）。本研究旨在评估职业治疗师的行为改变计划是否能增加接受 CIMT 的中风幸存者人数，描述首次实施该计划的时间和过程、任何不良事件、提供的 CIMT 的保真度和剂量，以及上肢结果。
采用可行性前后实施研究设计，对治疗师和中风幸存者进行干预和测量。治疗师的行为改变计划以行为改变轮为指导，包括 CIMT 培训、障碍识别、指导和实践社区。治疗师提供为期 2 周的 CIMT 计划，进行 1:1 监督，首先帮助中风幸存者使用加拿大职业表现量表确定上肢目标。主要结果是接受 CIMT 的中风幸存者人数变化（计划覆盖范围）。记录与计划实施相关的小时数、不良事件和参与者重复次数（计划保真度和剂量）。使用运动评估量表（上肢）、盒子和块测试、九孔钉测试和运动活动日志在基线、计划完成（2 周）、1 和 12 个月时测量运动功能变化（保真度）。
计划覆盖范围：在 24 个月内，共招募了 16 名中风参与者（平均发病后 15.3 个月，标准差 11.9），并开展了 6 个 CIMT 计划，而实施前没有开展任何 CIMT 计划。第一个 CIMT 计划的准备和实施共需要 242 个小时。所有的计划都有学生协助。保真度和剂量：中风参与者平均每小时完成 360.6 次重复（标准差 183.7），每个计划完成 12719.6 次重复（标准差 6872.8）。记录到上肢运动功能的显著变化，有些变化具有临床意义。
行为改变计划安全且真实地实施了多个 CIMT 计划。能力建设和技能发展需要花费大量时间，第一个 CIMT 计划的准备也需要大量时间。
