Jarvis, Kathryn (2016) Occupational therapy for the upper limb after stroke: implementing evidence-based constraint induced movement therapy into practice. Doctoral thesis, Keele University.

[img]
Preview
Text
JarvisPhD2016.pdf

Download (4MB) | Preview

Abstract

Background
Constraint induced movement therapy (CIMT), an intervention to increase upper limb (UL) function post-stroke, is not used routinely by therapists in the United Kingdom; reasons for this are unknown. Using the Promoting Action on Research Implementation in Health Services (PARIHS) framework to analyse CIMT research and context, a series of related studies explored implementation of CIMT into practice.

Methods and Findings
Systematic review: nineteen CIMT randomised controlled trials found evidence of effectiveness in sub-acute stroke, but could not determine the most effective evidence-based protocols. Further review of qualitative data found paucity of evidence relating to acceptability and feasibility of CIMT.
Focus group: perceptions of the feasibility, including facilitators and barriers, of implementing
CIMT into practice were explored in a group of eight therapists. Thematic analysis identified five
themes: personal characteristics; setting and support; ethical considerations; education and
training; and practicalities, which need to be addressed prior to implementation of CIMT.

Mixed-methods, pilot study (three single cases): pre- and post-CIMT (participant preferred protocol) interviews explored perceptions and experiences of CIMT, with pre- and post-CIMT measurement of participation and UL function. Findings indicated: (i) provision of evidence-based CIMT protocols was feasible, although barriers persisted; (ii) piloted data collection and analysis
methods facilitated exploration of stroke survivors’ perceptions and experiences, and recorded participation and UL function.

Conclusions
Findings traversed PARIHS elements (evidence, context, facilitation), and should be considered prior to further CIMT implementation. Future studies of CIMT should explore: effects of CIMT protocol variations; characteristics of stroke survivors most likely to benefit from CIMT; interactions between CIMT and participation.

Item Type: Thesis (Doctoral)
Subjects: R Medicine > RM Therapeutics. Pharmacology
Divisions: Faculty of Humanities and Social Sciences > School of Humanities
Depositing User: Lisa Bailey
Date Deposited: 03 Nov 2016 10:06
Last Modified: 03 Nov 2016 10:06
URI: http://eprints.keele.ac.uk/id/eprint/2412

Actions (login required)

View Item View Item