Adaption of a behaviour change intervention to support constraint-induced movement therapy (CIMT) delivery via telehealth

Research Objectives: To explore therapists’ perceived barriers and enablers to the delivery of CIMT programs via telehealth (TeleCIMT) and understand experiences and use of online resources to support TeleCIMT implementation.

Design: Prospective single group pre and post-test implementation study using mixed methods.

Setting: Ambulatory rehabilitation services within metropolitan Sydney, Australia.

Participants: Occupational Therapists and Occupational Therapy Managers delivering outpatient upper limb rehabilitation services post-stroke were recruited from three rehabilitation services.

Interventions: Relevant literature and the key barriers and facilitators to providing standard CIMT (identified in a previous study of face to face CIMT delivery (ACTIveARM)) were synthesised in phase 1. Key facilitators and barriers to the adoption of CIMT in the new context of telehealth were then identified and a behaviour change intervention developed using implementation mapping. Focus groups with therapists, managers and implementation researchers were then used to refine the behaviour change intervention prior to delivery.

Main Outcome Measures: The proportion of eligible stroke survivors who were offered and received a TeleCIMT program following delivery of the behaviour change intervention.

Results: Barriers to telehealth delivery included lack of therapist knowledge and skills, and lack of resources to delivery CIMT. This result was consistent with previous studies. Additional barriers identified included challenges for participants with accessing telehealth and an increased need for family member/carer engagement to support program delivery. The developed behaviour change intervention included online therapist training modules and an online community of practice. Preliminary outcomes associated with therapist adoption and delivery of TeleCIMT will be presented.

Conclusions: We describe the process of adapting an effective, theoretically-informed behaviour change intervention to a new context to support the delivery of evidence based upper limb rehabilitation via telehealth.

Author(s) Disclosures: LC declares she received funding support through a Stroke Foundation (Australia) Early Career Researcher grant and St Vincent's Clinic Foundation (Australia) Multidisciplinary Research grant to conduct this study.
NL declares she received Heart Foundation (Australia) funding (GNT102055).