Vurrabindi Divya, Hilderley Alicia J, Kirton Adam, Andersen John, Cassidy Christine, Kingsnorth Shauna, Munce Sarah, Agnew Brenda, Cambridge Liz, Herrero Mia, Leverington Eleanor, McCoy Susan, Micek Victoria, Connor Keith O, Grady Kathleen O', Reist-Asencio Sandra, Tao Chelsea, Tao Stephen, Fehlings Darcy
Bloorview Research Institute, Rehabilitation Sciences Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada.
University of Calgary, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
BMC Health Serv Res. 2025 Apr 4;25(1):503. doi: 10.1186/s12913-025-12621-z.
Cerebral Palsy (CP) is the most common childhood-onset motor disability. Play-based early intensive manual therapies (EIMT) is an evidence-based practice to improve long-term hand function particularly for children with asymmetric hand use due to CP. For children under two years old, this therapy is often delivered by caregivers who are coached by occupational therapists (OTs). However, why only a few Canadian sites implement this therapy is unclear. There is a need to identify strategies to support implementation of EIMT. The primary objective of this study was to identify the facilitators and barriers to EIMT implementation from the perspectives of (1) caregivers of children with CP (2), OTs and (3) healthcare administrators for paediatric therapy programs.
The Consolidated Framework for Implementation Research (CFIR) was used to guide development of an online 5-point Likert scale survey to identify facilitators (scores of 4 and 5) and barriers (scores of 1 and 2) to implementation of EIMT. Three survey versions were co-designed with knowledge user partners for distribution to caregivers, OTs, and healthcare administrators across Canada. The five most frequently endorsed facilitators and barriers were identified for each respondent group.
Fifteen caregivers, 54 OTs, and 11 healthcare administrators from ten Canadian provinces and one territory participated in the survey. The majority of the identified facilitators and barriers were within the 'Inner Setting' CFIR domain, with 'Structural Characteristics' emerging as the most reported CFIR construct. Based on the categorization of the most frequently endorsed facilitators and barriers within the CFIR domains, the key facilitators to EIMT implementation included the characteristics of the intervention and establishing positive workplace relationships and culture. The key barriers included having workplace restrictions on EIMT delivery models and external influences (e.g., funding) on EIMT uptake.
We identified key facilitators and barriers to implementing EIMT from a multi-level Canadian context. These findings will inform the next steps of designing evidence-informed and theory-driven implementation strategies to support increased delivery of EIMT for children under two years old with asymmetric hand use due to CP across Canada.
脑性瘫痪（CP）是儿童期最常见的运动障碍。基于游戏的早期强化手法治疗（EIMT）是一种循证实践，可改善长期手部功能，尤其适用于因CP导致手部使用不对称的儿童。对于两岁以下的儿童，这种治疗通常由在职业治疗师（OT）指导下的护理人员进行。然而，为何只有少数加拿大机构实施这种治疗尚不清楚。有必要确定支持EIMT实施的策略。本研究的主要目的是从（1）CP患儿的护理人员、（2）OT以及（3）儿科治疗项目的医疗保健管理人员的角度，确定EIMT实施的促进因素和障碍。
采用实施研究综合框架（CFIR）指导开发一份在线五点李克特量表调查问卷，以确定EIMT实施的促进因素（得分4和5）和障碍（得分1和2）。与知识用户合作伙伴共同设计了三个调查版本，分发给加拿大各地的护理人员、OT和医疗保健管理人员。为每个受访者群体确定了五个最常认可的促进因素和障碍。
来自加拿大十个省和一个地区的15名护理人员、54名OT和11名医疗保健管理人员参与了调查。确定的大多数促进因素和障碍都在CFIR的“内部环境”领域内，“结构特征”是报告最多的CFIR构建体。根据CFIR领域内最常认可的促进因素和障碍的分类，EIMT实施的关键促进因素包括干预措施的特点以及建立积极的工作场所关系和文化。关键障碍包括对EIMT实施模式的工作场所限制以及EIMT采用的外部影响（如资金）。
我们从加拿大的多层次背景中确定了EIMT实施的关键促进因素和障碍。这些发现将为设计循证和理论驱动的实施策略的下一步提供信息，以支持在加拿大为因CP导致手部使用不对称的两岁以下儿童增加EIMT的提供。
