Adult experiences of constraint-induced movement therapy programmes: a qualitative study using the Theoretical Domains Framework and Capability, Opportunity, Motivation – Behaviour system

Abstract

Aim: To explore the experiences of adults who completed a constraint-induced movement therapy (CIMT) programme, and the barriers and enablers to their participation. Methods: Qualitative design using semi-structured interviews. Stroke and brain injury survivors (n = 45) who had completed CIMT as part of their usual rehabilitation were interviewed 1 month post-CIMT. Interviews were audio-recorded, transcribed and imported into Nvivo for analysis. Inductive coding was used to identify initial themes. Themes were then deductively mapped to the Capability, Opportunity, Motivation – Behaviour system, a behaviour change model, to identify barriers and enablers to CIMT programme adherence and engagement. Results: Enablers influencing participation included being provided with education about the programme (Capability – psychological), seeing improvements in arm function (Motivation – reflective), being committed to the programme (Motivation – reflective) and having strong social support from staff, family and allied health students (Opportunity – social). The structured programme was a motivator and offered a way to fill the time, particularly during inpatient rehabilitation (Opportunity – physical). Barriers to participation included experiencing physical and mental fatigue (Capability – physical) and frustration early in the CIMT programme (Motivation – automatic), and finding exercises boring and repetitive (Motivation – automatic). Conclusion: Therapist provision of educational supports for CIMT participants and their families is important to maximise CIMT programme uptake. During CIMT delivery, we recommend the provision of positive feedback and coaching in alignment with CIMT principles, and the inclusion of social supports such as group-based programmes to enhance participant adherence.

Unlocking the restraint—Development of a behaviour change intervention to increase the provision of modified constraint‐induced movement therapy in stroke rehabilitation

“…Similarly, the success of community‐based mCIMT programs relies on patient engagement and carer support (Stark et al, 2019). mCIMT is an intensive program that, despite its efficacy, can be challenging to complete (Borch et al, 2015; Christie et al, 2022). The perceptions and experiences of patients and carers who undertake or support a mCIMT program will be investigated in future research to understand the feasibility of the RITH mCIMT program.…”

Remote constraint induced therapy of the upper extremity (ReCITE): A feasibility study protocol

“…Adoption of CIMT has not been universal, and numerous barriers to delivery are cited in the literature (15-17) as well as patient-identified barriers to participation (18). Specifically, the barriers to patient participation include the time commitment and intensity of CIMT, while enablers to completing a CIMT program include support from therapists, carers/supporters and seeing improvements in arm function (19). Recent research has shown that patients (n = 40) receiving either in-person or virtual CIMT were "highly satisfied" with CIMT overall and found it only "moderately difficult" to participate in, based on survey data (20).…”