Examining the use of constraint-induced movement therapy in canadian neurological occupational and physical therapy

Abstract

Purpose: To investigate the use of constraint-induced movement therapy (CIMT) in Canadian neurological occupational and physical therapy.

Method: An online survey was completed by occupational and physical therapists practising in Canadian adult neurological rehabilitation. We measured participants' practices, perceptions, and opinions in relation to their use of CIMT in clinical practice.

Results: A total of 338 surveys were returned for a 13% response rate; 92% of respondents knew of CIMT, and 43% reported using it. The majority (88%) of respondents using CIMT employed a non-traditional protocol. Self-rating of level of CIMT knowledge was found to be a significant predictor of CIMT use (p≤0.001). Commonly identified barriers to use included "patients having cognitive challenges that prohibit use of this treatment" and "lack of knowledge regarding treatment."

Conclusions: Although the majority of respondents knew about CIMT, less than half reported using it. Barriers to CIMT use include lack of knowledge about the treatment and institutional resources to support its use. Identifying and addressing barriers to CIMT use-for example, by using continuing professional education to remediate knowledge gaps or developing new protocols that require fewer institutional resources-can help improve the feasibility of CIMT, and thus promote its clinical application.

Keywords: constraint-induced movement therapy; rehabilitation; stroke; surveys; upper extremity.

Figures

Figure 1

Flow diagram of survey framework designed to identify participants who met the inclusion criteria and had used CIMT clinically in the past two years and to further classify respondents according to their use of CIMT.

Figure 2

Frequency of respondents identifying key components of CIMT who do (n=69) and do not (n=98) use CIMT. “Identified no components” refers to respondents who did not identify any of the key components of CIMT. RTP=Repetitive Task Practice.

Figure 3

Total duration (weeks) of traditional (n=8) vs. non-traditional (n=61) use of CIMT.

Figure 4

Parameters for use of traditional vs. non-traditional CIMT respectively, including: (A) days/week of restraint (n=8, n=60); (B) days/week of RTP/shaping (n=8, n=60); (C) hours/day of restraint (n=8, n=60); (D) hours/day of RTP/shaping (n=8, n=58). RTP=Repetitive Task Practice.

Figure 5

Most selected barriers to CIMT use (users of CIMT, n=58; non-users of CIMT, n=104). HR=Human Resources.