ReCITE (Remote Constraint Induced Therapy of the upper Extremity): An implementation study of remotely delivered constraint induced movement therapy for stroke survivors

Implementation: Outpatient therapy teams, including occupational therapists and allied health assistants, at four sites will be provided with an interactive implementation package to support delivery of constraint induced movement therapy program (CIMT) program via telehealth (TeleCIMT) in practice. Participating therapists will individually complete the two hour online TIDE (TeleCIMT International DEvelopment) TeleCIMT implementation package which includes education modules targeted at known barriers to CIMT implementation and "how to implement" the TeleCIMT program. This is readily available online via https://www.telecimt.com/. Therapists will be provided with a step by step CIMT participant workbook and access to online videos to assist with program preparation, via the TeleCIMT website. Following completion of online training, therapists will participate in a 3 hour practical workshop delivered in a hybrid format (therapists in-person in groups of 2-8 with 2 instructors from the study team delivering training online). The mode of instruction will include powerpoint presentation and pre-recorded videos of how to conduct the study screening assessments, group discussion of any areas requiring further explanation from the online training and presentation of a case study and group work to practice delivery of TeleCIMT. Adherence to therapist online training will be monitored by accessing website analytics. Following completion of modules and workshop, therapists will be involved in monthly virtual community of practice meetings, run for 12-18 months (until the final stroke participant has completed their CIMT program) to support therapists with implementing TeleCIMT into their setting. Intervention: Within 3 months of delivery of the implementation package to therapists, adults post-stroke with upper limb activity limitations who have some active movement in the hand will complete a three week constraint induced movement therapy program (CIMT) program via telehealth (TeleCIMT). Participants will be asked to complete a minimum of two hours active practice, five days per week for three weeks. Direct therapist intervention with participants will occur via video call three days per week for one hour. Outside of these sessions, participants will complete independent structured practice with their affected arm five days per week (2 hours twice a week and 1 hour on direct therapist intervention days), for 3 weeks (15 days) using a list of pre-defined activities. These activities will be set by the therapist in consultation with the stroke survivor to align with the participant's interests and roles and will be completed with or without the support of a carer/friend/family member. Participants will also be asked to wear a mitt restraint on the unaffected hand for 6 hours per day. Participants will also have a short (10-20 minutes) daily telephone call with their treating therapist (Monday-Friday) to receive support to problem solve strategies to increase use of their affected arm (CIMT transfer package). Adherence to the mitt wear and structured practice will be recorded in the participant's workbook with or without help from the support person and also recorded by the therapists during the daily phone calls.