Implementation and sustainability of upper limb constraint-induced movement therapy programs for adults with neurological conditions: an international qualitative study
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 5 January 2021
Issue publication date: 13 October 2021
Abstract
Purpose
Constraint-induced movement therapy (CIMT) is an effective intervention for arm recovery following acquired brain injury; however, there is an evidence-practice gap between research and CIMT use in practice. The aim of this study was to identify individual, organisational and social factors enabling implementation and sustained delivery of CIMT programs internationally.
Design/methodology/approach
Descriptive qualitative design. Purposive sampling was used to recruit occupational therapists and physiotherapists with previous experience delivering CIMT. Semi- structured interviews were conducted, using an interview schedule informed by the Theoretical Domains Framework (TDF) to explore individual factors (such as knowledge, skills and beliefs), organisational factors (such as organisational culture and resources) and social factors (such as leadership) influencing CIMT implementation. Interviews were audio-recorded, transcribed and managed using NVivo. The TDF guided data analysis and identification of key influences on CIMT implementation and sustainability.
Findings
Eleven participants (n = 7 [63.6%] occupational therapists and n = 4 [36.4%] physiotherapists) were interviewed from six countries, working across public (n = 6, 54.6%) and private health (n = 5, 45.5%). Six key domains influenced CIMT implementation and sustainability. Clinicians needed knowledge and opportunities to apply their skills, and confidence in their ability to implement CIMT. Within their workplace, supportive social influences (including broader team support), the environmental context (including organisational culture and resources) and reinforcement from seeing positive outcomes contributed to implementation and sustainability. Other important influences included community demand and tailoring of programs to meet individual needs.
Originality/value
This is the first study to examine therapists' experiences of CIMT implementation and sustainability across multiple countries. Factors related to capacity building, social and organisational support and resources enabled CIMT program implementation and ongoing sustainability. These findings can be used to design behaviour change interventions to support CIMT use in practice.
Keywords
Acknowledgements
The authors would like to thank the individuals who generously shared their time and experiences for the purposes of this research.DeclarationsEthics approval and consent to participate: All participants received an electronic copy of the participant information sheet and consent form. Written informed consent was obtained from participants prior to interview. Approval was obtained from The University of Sydney Human Research Ethics Committee in April 2016 (project no 2016/074).Consent for publication: Not applicable.Availability of data and material: Data that support study findings are available upon request from the corresponding author [LC], but restrictions apply in accordance with the approved ethics protocol. Confidential data are not publicly available as some information could compromise research participant privacy/consent.Competing interests: The authors declare that they have no competing interests.Funding: The research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Authors' contributions: LC conceptualised the study and collected all data. LC, AM and ML contributed to the design of the study, data analysis, preparation of the manuscript, and approved the final version.
Citation
Christie, L.J., McCluskey, A. and Lovarini, M. (2021), "Implementation and sustainability of upper limb constraint-induced movement therapy programs for adults with neurological conditions: an international qualitative study", Journal of Health Organization and Management, Vol. 35 No. 7, pp. 904-923. https://doi.org/10.1108/JHOM-07-2020-0297
Publisher
:Emerald Publishing Limited
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