Current Practice “Constraints” in the Uptake and Use of Intensive Upper Extremity Training: A Canadian Perspective

ABSTRACT

Background: Intensive upper extremity training (IUET) has demonstrated efficacy in clinical and functioning outcomes in children with hemiplegia. However, implementation in the clinical context requires novel service models and knowledge translation. Aims: To map implementation of IUET in Canada, to identify factors associated with the implementation and best practices for implementation. Methods: Mixed-methods design; descriptive statistics, chi-square tests. Individual phone interviews and focus groups with purposeful sampling. Thematic analysis; telephone surveys with managers of 31 pediatric rehabilitation centers across Canada. Four focus groups across Canada and one in the Netherlands. Results: Implementation of IUET group interventions is limited in Canada (7/31). Barriers included beliefs and values related to evidence-based practice, opportunities for continuing education, researchers-clinicians partnerships, access to scientific literature, and the presence of a champion. Pressure from parents and media presenting IUET as a novel and effective therapy, support and flexibility of families, having the critical mass of clients and a managerial willingness to accommodate new ideas and restructure service provision were some facilitators. Conclusions: Uptake of the evidence requires many steps described in the knowledge translation cycle. Factors identified in the study could be considered in most clinical settings to facilitate the uptake of research evidence for IUET.

KEYWORDS:

• Bimanual therapy
• cerebral palsy
• constraint-induced movement therapy
• evidence-based practice
• hemiplegia
• upper extremity training

Acknowledgments

The authors would like to thank Joey Waknin, Leo Saba, and Annahita Ehsan for research assistance, Nathalie Trudelle and Desirée Maltais for assistance with workshops organization, and Eugene Ramecken, Linda Fay, France Martineau, and Vasiliki Darkalis for assistance with focus groups organization.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

About the Authors

Dr. Keiko Shikako-Thomas is the Canada Research Chair in Childhood Disability: Participation and Knowledge Translation, and assistant professor at the School of Physical and Occupational Therapy at McGill University. Her research focus on promoting participation for children with disabilities, and developing methods to engage stakeholders in research and disseminate research-based evidence to community and policymaking. Dr. Darcy Fehlings is Head of the Division of Developmental Paediatrics and is a Professor in the Department of Paediatrics, at the University of Toronto. Her research focuses on the innovation and evaluation of interventions for children with cerebral palsy. Manon Germain is an Occupational Therapist at the Centre de Readaptation Marie Enfant in Montreal, Canada. Dr. Andrew M. Gordon is a Professor of Movement Science at Teachers College, Columbia University. His research focuses on the neural mechanisms underlying cerebral palsy and developing and testing evidence-based therapeutic interventions. Doug Maynard is the Associate Director of the Canadian Association of Paediatric Health Centres (CAPHC). Doug leads many national knowledge translation initiatives for CAPHC, engaging a multidisciplinary community of health service providers from organizations that reflect the continuum of health services for children and youth in Canada. Dr. Annette Majnemer is Professor at the School of Physical & Occupational Therapy, and Vice Dean - Education in the Faculty of Medicine at McGill University; and is Senior Scientist at the Research Institute of the McGill University Health Centre. Her research focuses on the early identification of developmental disabilities and the determinants of the outcomes of these children.

Additional information

Funding

This study was funded by the Edith Strauss Foundation, Rehabilitation Knowledge Translation projects.