Increasing the delivery of upper limb constraint-induced movement therapy programs for stroke and brain injury survivors: evaluation of the ACTIveARM project

To increase the number of constraint-induced movement therapy (CIMT) programs provided by rehabilitation services. A before-and-after implementation study involving nine rehabilitation services. The implementation package to help change practice included file audit–feedback cycles, 2-day workshops, poster reminders, a community-of-practice and drop-in support. File audits were conducted at baseline, every three months for 1.5 years, and once after support ceased to evaluate maintenance of change. CIMT participant outcomes were collected to evaluate CIMT effectiveness and maintenance (Action Research Arm Test and Motor Activity Log). Staff focus groups explored factors influencing CIMT delivery. CIMT adoption improved from baseline where only 2% of eligible people were offered and/or received CIMT (<i>n</i> = 408 files) to more than 50% over 1.5 years post-implementation (<i>n</i> = 792 files, 52% to 73% offered CIMT, 27%–46% received CIMT). Changes were maintained at 6-month follow-up (<i>n</i> = 172 files, 56% offered CIMT, 40% received CIMT). CIMT participants (<i>n</i> = 74) demonstrated clinically significant improvements in arm function and occupational performance. Factors influencing adoption included interdisciplinary collaboration, patient support needs, intervention adaptations, a need for continued training, and clinician support. The implementation package helped therapists overcome an evidence-practice gap and deliver CIMT more routinely. Constraint induced movement therapy (CIMT) is a highly effective intervention for arm recovery after acquired brain injury, recommended in multiple clinical practice guidelines yet delivery of CIMT in practice remains rare.A multifaceted implementation package including clinician training workshops, a community of practice, drop in support and regular audit and feedback cycles improved delivery of CIMT programs in practice by neurorehabilitation teams.Stroke survivors and people with brain injury who received a CIMT program in usual practice demonstrated clinically important improvements in arm function, dexterity and occupational performance. Constraint induced movement therapy (CIMT) is a highly effective intervention for arm recovery after acquired brain injury, recommended in multiple clinical practice guidelines yet delivery of CIMT in practice remains rare. A multifaceted implementation package including clinician training workshops, a community of practice, drop in support and regular audit and feedback cycles improved delivery of CIMT programs in practice by neurorehabilitation teams. Stroke survivors and people with brain injury who received a CIMT program in usual practice demonstrated clinically important improvements in arm function, dexterity and occupational performance.

为提升康复服务机构所提供的约束诱导运动疗法（Constraint-induced movement therapy, CIMT）项目的覆盖数量。本研究为一项纳入9家康复服务机构的前后对照实施研究。用于推动临床实践变革的实施包涵盖病历档案审核-反馈循环、2天专业工作坊、可视化海报提示、实践社群建设以及即时支持服务。病历档案审核分别于基线阶段、实施后每3个月开展1次，持续1.5年，并在支持服务停止后额外开展1次，以评估干预效果的维持情况。研究收集CIMT参与者的结局数据，采用动作研究臂测试（Action Research Arm Test）与运动活动日志（Motor Activity Log）评估CIMT的临床有效性及效果维持水平。此外，通过工作人员焦点小组访谈，探究影响CIMT临床实施的各类因素。

CIMT的临床使用率从基线阶段的2%（仅2%的符合条件人群被提供并/或接受CIMT，n=408份诊疗档案）提升至实施后1.5年期间的50%以上（n=792份诊疗档案，52%~73%的人群被提供CIMT，27%~46%的人群实际接受了CIMT）。在支持服务停止后的6个月随访阶段，干预效果仍得以维持（n=172份诊疗档案，56%的人群被提供CIMT，40%的人群接受了CIMT）。共纳入74名CIMT参与者，其上肢功能与作业表现均出现具有临床意义的显著改善。影响CIMT临床实施的关键因素包括多学科团队协作、患者支持需求、干预方案个性化调整、持续培训的必要性以及临床医师支持。该实施包帮助治疗师弥合了循证证据与临床实践之间的差距，使CIMT的常规开展更为可行。

约束诱导运动疗法（CIMT）是针对获得性脑损伤后上肢康复的高效干预手段，多项临床实践指南均对其予以推荐，但临床实际中CIMT的常规开展仍较为罕见。
多维度实施包涵盖临床医师培训工作坊、实践社群、即时支持服务以及定期的病历档案审核-反馈循环，有效提升了神经康复团队在临床实践中开展CIMT项目的覆盖率。
在常规诊疗流程中接受CIMT项目的脑卒中幸存者与脑损伤患者，其上肢功能、肢体灵活性与作业表现均出现具有临床意义的显著改善。
约束诱导运动疗法（CIMT）是针对获得性脑损伤后上肢康复的高效干预手段，多项临床实践指南均对其予以推荐，但临床实际中CIMT的常规开展仍较为罕见。
多维度实施包涵盖临床医师培训工作坊、实践社群、即时支持服务以及定期的病历档案审核-反馈循环，有效提升了神经康复团队在临床实践中开展CIMT项目的覆盖率。
在常规诊疗流程中接受CIMT项目的脑卒中幸存者与脑损伤患者，其上肢功能、肢体灵活性与作业表现均出现具有临床意义的显著改善。