Christie L, McCluskey A, & Lovarini M (2019, online early). Constraint-induced movement therapy for upper limb recovery in adult neurorehabilitation: An international survey of current knowledge and experience. Australian Occupational Therapy Journal.

This is the first publication from Lauren Christie’s PhD about the implementation and sustainability of upper limb CIMT. While helping 9 teams in Sydney to implement CIMT over the past 2 years, Lauren has also completed this international survey of ‘users’ of CIMT.

A total of 169 OTs and PTs from across the globe responded to the online survey. Some of our StrokeEd followers may have completed the survey (thankyou). All respondents had delivered at least one CIMT program in the previous year. More responses were received from UK (36%) and Australia (28%).

Individual CIMT is more often provided than group-based CIMT. the 2-week model is most common (63%). Patients are most often in the sub-acute or chronic phase, with few acute/early stages receiving CIMT (12%).

Daily CIMT sessions run for 1-hr/day (30%), 2-hrs/day (11%), 3-hrs/day (7%), 4-hrs/day (12%), and even 6-hrs/day (11%). Programs either run over 5 days/week (41%) or 7-days/week (36%).

About half of the respondents deliver between 2-6 CIMT programs per year (56%) and only 14% reported delivering more than 6 programs annually.

Therapists mostly learn about CIMT by reading (brief) methods in journal articles (82%) or practice guidelines (65%), learning from others at work /workplace learning (53%) and peers (56%).

Less than half of the 169 respondents had attended a CIMT training workshop – this study found workshop attendance was correlated with greater confidence and knowledge of CIMT, esp program components and fidelity. Clearly more workshops are needed and more therapists would benefit from attending, esp when patient participants are involved to enable practice.

Only one third of respondents (39%) report using the all-important ‘transfer package’ to promote behaviour change – which included homework tasks, diary, behavioural contract, daily completion of the MAL.

Anyone wishing to read about the transfer package should read Taub et al (2013) Method for enhancing real world use of a more affected arm in chronic stroke: Transfer package of CIMT. Stroke, 44(5), 1383-8.(NB much of the detailed info is in the Supp Files).

Overall, this article provides a snapshot of CIMT programs internationally. It is promising to see that here in Australia, at least 48 OTs/PTs ARE delivering CIMT although the 2016 national audit found that only 9% of eligible stroke survivors had received CIMT.