Rehabilitation in the Home, South Metropolitan Health Service, Department of Health, Fremantle, Australia.
School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
Aust Occup Ther J. 2023 Dec;70(6):661-677. doi: 10.1111/1440-1630.12896. Epub 2023 Jul 9.
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.
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).
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.
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.
大量证据表明，提供改良强制性运动疗法（mCIMT）可改善脑卒中后的上肢功能。一项服务审核发现，在大型亚急性、早期支持出院康复服务中，很少有患者接受 mCIMT。由于首次“仅教育”尝试不成功，因此开发了一种行为改变干预措施来增加 mCIMT 的提供。本文旨在系统记录所采取的步骤，并为临床医生和康复服务提供实用指南，以实施这种复杂但有效的康复干预措施。
该临床医生行为改变干预措施分五个阶段制定，由一组神经学专家（n=3）领导。数据收集方法包括与临床医生的非正式讨论和在线调查（n=35）。该分阶段过程包括反思为何首次尝试未能改善 mCIMT 的提供（第 1 阶段），根据理论领域框架（TDF）和行为改变车轮（BCW）映射障碍和促进因素以指导行为改变技术（第 2 阶段和第 3 阶段），制定合适的 mCIMT 方案（第 4 阶段），以及实施行为改变干预（第 5 阶段）。
工作组的反思确定需要提高 mCIMT 提供方面的技能，并使用行为改变框架来指导实施计划。行为改变的关键决定因素在 TDF 领域的知识、技能、环境背景和资源、社会角色和身份以及社会影响中运作。在制定特定于环境的 mCIMT 方案之后，BCW 指导了行为改变干预措施，其中包括教育、培训、说服、环境重构和示范。
本文提供了一个使用 TDF 和 BCW 来支持在大型早期支持出院服务中实施 mCIMT 的示例。它概述了用于影响临床医生行为的行为改变技术套件。未来的研究将探讨这种行为改变干预措施的成功。
