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Constraint-Induced Movement Therapy in SESLHD: The feasibility of using a student-assisted model. Jessica Worton - Neurological Rehabilitation, St George Hospital, Sydney (for SESLHD)
Background • Constraint-Induced Movement Therapy (CIMT) has strong evidence in the Australian Clinical Guidelines for Stroke Management (2017) Reference: Stroke Foundation (2017). Clinical Guidelines for Stroke Management 2017. Melbourne, Australia. Retrieved from https://app.magicapp.org/app#/guideline/2282
Background • Within South Eastern Sydney Local Health District (SESLHD) CIMT has not been provided consistently or with fidelity. • Clinicians who reported previous use of CIMT did not demonstrate knowledge of all essential components. • Perceived lack of time and resources was a barrier
Aim • To investigate the feasibility of delivering CIMT via a student-assisted model for patients following a stroke.
Acknowledgements Clinicians Project Team Jessica Worton (Project Lead – SESLHD) Karleen Dumbrell (OT advisor – SESLHD) Daniel Treacy (PT advisor – SESLHD) Becky Walsh, Dan Shaw, Leshae Johnston (Improvement and Innovation Hub, SESLHD) Prince of Wales Hospital Clare Griffin (OT) Elizabeth Hobbs (AHA) Jayne Agostino (OT) Karin Vogel (OT) Kathleen Makgroglou (OT) Kelly Drowley (OT) Lauren Taylor (OT) Madeline Petrie (OT) Stephanie Potts (PT) Whitney Harris (PT) St George Hospital Callie Chan (OT) Lauren Stanwell (PT) Leisa Johns (PT) MillinaSavann (OT) Nicole Austin (PT) Sutherland Hospital Alex Piepers (PT) Deanne Miro (PT) Elise Klumpes-Grant (OT) Genna O’Neill (OT) Michelle Reed (OT) Special Thanks Stephanie Ho (consumer rep & steering committee member) OT and Physiotherapy Department Managers – Prince of Wales Hospital, St George Hospital, Sutherland Hospital Claire O’Connor – Director of Allied Health SESLHD Rehabilitation Physicians – Prince of Wales Hospital, St George Hospital, Sutherland Hospital Physio and OT students, 2018-2019 (ACU and Macquarie University) Deirdre Cooke (ACU Brisbane), Lauren Christie (Liverpool Hospital), Lauren Rutzou (St Joseph’s Hospital), Phillip Fay (Constraint Induced Therapy Australia)
Outcome • Development • CIMT structure • Identify clinicians and run CIMT course • Resources developed • Dates set, students requested • Student orientation program and tutorials • Participants identified • Intranet and internet sites SESLHD website: https://www.seslhd.health.nsw.gov.au/services-clinics/directory/constraint-induced-movement-therapy-cimt
Outcome • 5 programs run in 2018/19 – 28 participants • 6 patients: 6 students: 2 clinicians • Participant demographics
Assessments • Motor Assessment Scale – Upper limb items • Box and Block test • Nine hole peg test • Motor Activity Log • Canadian Occupational Performance Measure
Results Average change of 2.52 points on 18 point scale
Results Average increase in blocks transferred in 1 minute - 5.26 Average reduction of time taken to complete test - 17.44 seconds
Results Average rating increased by 1.26 points on a 5 point scale Average rating increased by 1.42 points on a 5 point scale
Results Average increase in rating was 2.21 points Average increase in rating was 2.74 points
Outcome • Student program
Outcome • Comparing models 24 hours of clinician time per patient 52 hours of clinician time per patient
Outcome • Comparing models $2166 per patient $979 per patient
Outcome • Comparing models
Outcome Delivering CIMT to 6 patients Time saving = 167 hours of clinician time Cost saving = $7122
Conclusion • A student assisted model of CIMT delivery to a group is feasible • Less impact on clinician time • Reduced cost to the organisation • Participant results are good
Questions? Contact Details: Jessica Worton Email: firstname.lastname@example.org Phone: 9113 2395 References Chen, H.M., Chen, C.C., Hsueh, I., Huang, S., Hseih, C. (2009). Test-retest reproducibility and smallest real difference of five hand function tests in patients with stroke. Neurorehabil Neural Repair, 23(5), 435-440. Law, M., Baptiste, S., et al. (2004). COPM questions and answers. From http://caot.ca/copm/questions.html Simpson, L.A., & Eng, J.J. (2013). Functional recovery following stroke: Capturing changes in upper extremity function. Neurorehabil Neural Repair, 27(3), 240-250. Stroke Foundation (2017). Clinical Guidelines for Stroke Management 2017. Melbourne, Australia. Retrieved from https://app.magicapp.org/app#/guideline/2282 Wolf, S.L., Thompson, P.A., Winstein, C.J, Miller, J.P, Blanton, S.R., Nicols-Larsen, D.S., Morris, D.M., Uswatte, G., Taub, E., Light, K.E, & Sawaki, L. (2010). The EXCITE Stroke Trial Comparing Early and Delayed Constraint-Induced Movement Therapy. Stroke, 41, 2309-2315. DOI: 10.1161/STROKEAHA.110.588723