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.

为提升康复服务所提供的约束诱导运动疗法（Constraint-induced movement therapy, CIMT）项目数量，本研究开展了一项涉及9家康复服务机构的前后对照实施性研究。用于推动实践变革的综合实施包涵盖文件审核-反馈循环、2天专业培训工作坊、海报提醒、实践社区及随到随享支持。研究分别于基线阶段、为期1.5年的每3个月节点，以及支持措施终止后开展文件审核，以评估实践变革的维持情况。本研究通过动作研究臂测试（Action Research Arm Test）与运动活动日志（Motor Activity Log）收集CIMT参与者的结局数据，用以评价CIMT的干预效果及效果持久性；同时通过员工焦点小组访谈，探讨影响CIMT临床开展的相关因素。

研究结果显示，CIMT的应用覆盖率从基线阶段的2%（符合条件的人群中仅2%被提供或接受CIMT，n=408份病历）提升至实施后1.5年的50%以上，其中52%~73%的符合人群被提供CIMT，27%~46%实际接受了该疗法（n=792份病历）；在支持措施终止6个月后的随访中，该改善趋势得以维持（n=172份病历，56%的符合人群被提供CIMT，40%实际接受）。共74名CIMT参与者的上肢功能与作业表现均出现具有临床意义的改善。

研究发现，影响CIMT推广的关键因素包括跨学科协作模式、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生支持。本研究的综合实施包帮助治疗师克服了循证实践缺口，实现了CIMT的常规化开展。

约束诱导运动疗法（CIMT）是针对获得性脑损伤后上肢功能恢复的高效干预手段，已被多项临床实践指南推荐，但临床实际中该疗法的开展仍较为罕见。本项包含临床医生培训工作坊、实践社区、随到随享支持及定期文件审核-反馈循环的综合实施包，有效提升了神经康复团队在临床中开展CIMT项目的比例。在常规临床实践中接受CIMT的脑卒中幸存者及脑损伤患者，其上肢功能、灵活性及作业表现均出现具有临床意义的显著改善。