Rehabilitation in the Home, South Metropolitan Health Service, Perth, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
Rehabilitation in the Home, South Metropolitan Health Service, Perth, Australia.
J Physiother. 2023 Oct;69(4):249-259. doi: 10.1016/j.jphys.2023.08.007. Epub 2023 Sep 9.
To summarise and synthesise the qualitative literature relating to constraint-induced movement therapy (CIMT) among stroke survivors, carers, therapists and rehabilitation service managers.
Systematic review of qualitative studies. Quantitative studies using survey data were also included if they investigated perceptions and/or experiences related to CIMT.
Cochrane Library, Medline, JBI, Emcare, Embase, PsycInfo, CINAHL, PEDro, OT Seeker and NICE from inception to January 2022.
Two reviewers independently extracted data from the included studies and assessed comprehensiveness of reporting using established tools. Thematic synthesis was undertaken to synthesise findings for studies using focus groups and interviews. A summary of themes from quantitative studies using survey data was compiled to complement the qualitative synthesis.
Searches yielded 1,450 titles after removal of duplicates; 60 full-text articles were assessed for eligibility and 14 studies were included (1,570 total participants). Thematic synthesis identified nine descriptive themes from which four analytical themes were developed: CIMT is challenging but support at all levels helps; therapists need the know-how, resources and staffing; CIMT is different to other interventions, and there are positives and negatives to this; and functional outcomes do not always meet high expectations. Quantitative survey themes included: knowledge, skills and confidence in delivering CIMT programs; patient factors; and institutional factors.
This review identified several determinants of implementation related to CIMT. Rehabilitation therapists need to develop their knowledge and skills to deliver CIMT, engage with organisational leaders, and develop CIMT protocols to fit the local clinical context in order to sustainably deliver CIMT in stroke rehabilitation services. Stroke survivors and carers require improved education to increase their engagement and participation. After addressing these determinants, future research should evaluate population-level outcomes and policy-level implementation in establishing CIMT as global standard rehabilitation practice.
CRD42021237757.
总结和综合与中风幸存者、照顾者、治疗师和康复服务管理者相关的强制性运动疗法（CIMT）的定性文献。
定性研究的系统综述。如果定量研究使用调查数据，且调查了与 CIMT 相关的看法和/或经验，则也包括这些研究。
从创建到 2022 年 1 月的 Cochrane 图书馆、Medline、JBI、Emcare、Embase、PsycInfo、CINAHL、PEDro、OTSeeker 和 NICE。
两名评审员独立从纳入的研究中提取数据，并使用既定工具评估报告的全面性。采用专题综合法对使用焦点小组和访谈的研究进行结果综合。编译了使用调查数据的定量研究的主题摘要，以补充定性综合。
在去除重复项后，检索得到 1450 个标题；对 60 篇全文文章进行了资格评估，纳入了 14 项研究（共 1570 名参与者）。专题综合确定了 9 个描述性主题，从中得出了 4 个分析性主题：CIMT 具有挑战性，但各级支持有助于实施；治疗师需要专业知识、资源和人员配置；CIMT 与其他干预措施不同，有利有弊；功能结果并不总能满足高期望。定量调查主题包括：实施 CIMT 计划的知识、技能和信心；患者因素；以及机构因素。
本综述确定了与 CIMT 实施相关的几个实施决定因素。康复治疗师需要发展他们的知识和技能来实施 CIMT，与组织领导合作，并制定适合当地临床环境的 CIMT 方案，以便在中风康复服务中可持续地实施 CIMT。中风幸存者和照顾者需要加强教育，以提高他们的参与度和积极性。在解决这些决定因素后，未来的研究应评估人口水平的结果和政策层面的实施，以确立 CIMT 为全球标准康复实践。
CRD42021237757。
