Implementation and sustainability of upper limb constraint-induced movement therapy programs for adults with neurological conditions: an international qualitative study

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Lauren J. Christie ◽  
Annie McCluskey ◽  
Meryl Lovarini
Keyword(s):  
Program Implementation ◽  
Social Factors ◽  
Theoretical Domains Framework ◽  
Occupational Therapists ◽  
Movement Therapy ◽  
Organisational Culture ◽  
Structured Interviews ◽  
Content Type ◽  
Constraint Induced Movement Therapy ◽  
Design Behaviour

PurposeConstraint-induced movement therapy (CIMT) is an effective intervention for arm recovery following acquired brain injury; however, there is an evidence-practice gap between research and CIMT use in practice. The aim of this study was to identify individual, organisational and social factors enabling implementation and sustained delivery of CIMT programs internationally.Design/methodology/approachDescriptive qualitative design. Purposive sampling was used to recruit occupational therapists and physiotherapists with previous experience delivering CIMT. Semi- structured interviews were conducted, using an interview schedule informed by the Theoretical Domains Framework (TDF) to explore individual factors (such as knowledge, skills and beliefs), organisational factors (such as organisational culture and resources) and social factors (such as leadership) influencing CIMT implementation. Interviews were audio-recorded, transcribed and managed using NVivo. The TDF guided data analysis and identification of key influences on CIMT implementation and sustainability.FindingsEleven participants (n = 7 [63.6%] occupational therapists and n = 4 [36.4%] physiotherapists) were interviewed from six countries, working across public (n = 6, 54.6%) and private health (n = 5, 45.5%). Six key domains influenced CIMT implementation and sustainability. Clinicians needed knowledge and opportunities to apply their skills, and confidence in their ability to implement CIMT. Within their workplace, supportive social influences (including broader team support), the environmental context (including organisational culture and resources) and reinforcement from seeing positive outcomes contributed to implementation and sustainability. Other important influences included community demand and tailoring of programs to meet individual needs.Originality/valueThis is the first study to examine therapists' experiences of CIMT implementation and sustainability across multiple countries. Factors related to capacity building, social and organisational support and resources enabled CIMT program implementation and ongoing sustainability. These findings can be used to design behaviour change interventions to support CIMT use in practice.

scholarly journals Modified Constraint-Induced Movement Therapy at Home—Is It Possible? Families and Children’s Experience

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 248
Author(s):  
Rocío Palomo-Carrión ◽  
Helena Romay-Barrero ◽  
Rita-Pilar Romero-Galisteo ◽  
Elena Pinero-Pinto ◽  
Purificación López-Muñoz ◽  
...  
Keyword(s):  
Upper Limb ◽  
Intensive Therapy ◽  
Movement Therapy ◽  
Interview Data ◽  
Future Application ◽  
Structured Interviews ◽  
Her Family ◽  
Constraint Induced Movement Therapy ◽  
Parents And Children ◽  
At Home

Modified constraint-induced movement therapy (mCIMT) is efficient at improving upper limb non-use. The experiences of families and children with mCIMT could allow researchers to understand how it influences their day-to-day life and to improve the function of the affected upper limb without altering family life and avoiding frustration. In this qualitative study, we aimed to collect the experiences of parents and their children (aged 4–8 years) who did mCIMT at home regarding the application of low-intensity modified constraint-induced movement therapy to improve the affected upper limb functionality in infantile hemiplegia with moderate manual ability. Individual semi-structured interviews were performed to obtain insights into their experience with mCIMT. The experiences of parents and children were described in thematic sections. Eight children with hemiplegia (six years, standard deviation, SD: 1.77) and their parents were asked about their experiences after applying 50 h of mCIMT at home. Three main themes emerged from the children’s interview data: (1) the experience of wearing the containment in the modified constraint-induced movement therapy (CIMT) intervention, (2) the reaction to performing the therapy at home with his/her family, and (3) learning of the affected upper limb. In the parents’ interview data, there were two main themes: (1) the difficulty of executing an intensive therapy protocol (mCIMT: 50 h) at home and (2) the feeling of not wanting to finish the intervention. The experiences of the parents and their children regarding mCIMT allowed us to understand the facilitators and barriers that affect the execution of mCIMT at home, and this understanding allows us to improve its future application.

Implementing combined assurance: insights from multiple case studies

2015 ◽  
Vol 30 (1) ◽  
pp. 56-79 ◽  
Author(s):  
Loïc Decaux ◽  
Gerrit Sarens
Keyword(s):  
Case Studies ◽  
Program Implementation ◽  
Audit Committees ◽  
Structured Interviews ◽  
Content Type ◽  
Internal Auditors ◽  
Implementation Stages ◽  
Multiple Case ◽  
Implementation Data ◽  
Implementation Stage

Purpose – This purpose of this paper is to investigate how to implement a combined assurance program. Design/methodology/approach – This paper uses qualitative data obtained through semi-structured interviews with six multinationals at different stages of combined assurance implementation maturity. Findings – The paper finds that organizations are still learning through combined assurance implementation because no organization seems to have attained a mature combined assurance program. Nevertheless, our descriptive findings reveal that a successful combined assurance implementation follows six important components. Research limitations/implications – One limitation of this study is that, as the organizations studied are at different stages of combined assurance program implementation, data may have comparability issues. Another limitation is that different interviewees were studied from one case to another. Practical implications – The results have implications both for organizations that do not yet have a combined assurance program in place and for those currently at the implementation stage. It has also implications for chief audit executives who are good candidates to lead a combined assurance implementation and for regulators, as the study describes combined assurance as an important accountability mechanism that helps boards and audit committees exercise their oversight role properly. Originality/value – The study is the first to address combined assurance implementation. It complements the study of the Institute of Internal Auditors UK and Ireland (2010), which identifies the reasons for failed attempts to coordinate assurance activities, by illustrating combined assurance implementation through six international case studies of organizations at different combined assurance implementation stages.

scholarly journals An exploration of engagement in community based creative activities as an occupation for older adults

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Luned Edwards ◽  
Bethan Owen-Booth
Keyword(s):  
Older Adults ◽  
National Policy ◽  
Occupational Therapists ◽  
Well Being ◽  
Phenomenological Approach ◽  
Ageing Population ◽  
Creative Arts ◽  
Structured Interviews ◽  
Community Based ◽  
Content Type

Purpose The purpose of this study was to explore the experiences of older adults (aged 60 and over) participating in community-based creative arts. With an ever increasing ageing population, understanding the benefits of leisure occupations such as community creative arts will be vital for Occupational Therapists in facilitating participation and active engagement. Design/methodology/approach An empirical qualitative research design with an interpretive phenomenological approach was undertaken. A purposive sampling method enlisted four older adult volunteers whose experiences of creative arts were explored through semi-structured interviews. Interview data were analysed thematically. Findings Participants identified many benefits of engaging in community creative arts. Four main themes were identified, namely, “personal benefits”, “choice” in their occupation, “encouragement” to and from others, with the environment facilitating “socialising”. These resulted in improved occupational performance and positive well-being outcomes. Originality/value The study complements national policy and extends evidence-based practice on the potential well-being benefits on older adults. In support of the preventative agenda, occupational therapists may apply these findings to increase social prescribing within practice.

Occupational Therapists’ Opinions of Two Pediatric Constraint-Induced Movement Therapy Protocols

2015 ◽  
Vol 69 (6) ◽  
pp. 6906180020p1 ◽  
Author(s):  
Emily Christman ◽  
Kaitlin McAllister ◽  
Katie Claar ◽  
Samantha Kaufman ◽  
Stephen J. Page
Keyword(s):  
Occupational Therapists ◽  
Movement Therapy ◽  
Constraint Induced Movement Therapy

scholarly journals The Perceptions of Pediatric Occupational Therapists Regarding Constraint-Induced Movement Therapy

2019 ◽  
Vol 7 (2) ◽  
Author(s):  
Sapna Chakraborty ◽  
Kelsey Dulin ◽  
Rachel Murphy ◽  
Haley Richardson ◽  
Makaila Schieber ◽  
...  
Keyword(s):  
Occupational Therapists ◽  
Movement Therapy ◽  
Constraint Induced Movement Therapy

scholarly journals The evolving role of occupational therapists in adult critical care in England

2019 ◽  
Vol 47 (2) ◽  
pp. 74-94 ◽  
Author(s):  
Naomi Algeo ◽  
Leanne M. Aitken
Keyword(s):  
Critical Care ◽  
Discharge Planning ◽  
Occupational Therapists ◽  
Evidence Base ◽  
Future Research ◽  
Service Utilisation ◽  
Structured Interviews ◽  
Online Questionnaire ◽  
Content Type ◽  
Upper Limb Function

Purpose A recent paradigm-shift in patient care advocates for long-term recovery and quality of life in survivors of critical illness. Evidence suggests that occupational therapists in critical care can contribute to recovery in areas such as functional outcomes, length of stay and delirium, although poor role understanding can limit service-utilisation. The purpose of this study is to investigate current and future roles and practices of critical care occupational therapists in the UK. Design/methodology/approach Occupational therapists with clinical experience in adult critical care were invited to participate in a mixed-methods design using a locally developed online questionnaire and semi-structured interviews, concurrently. Descriptive statistics were generated through SPSS. Qualitative data were analysed using the framework approach. Findings Twelve occupational therapists participated in the survey element, with five continuing to interview. Occupational therapists described a multifaceted role in critical care where the majority reported practice in upper limb function, seating/positioning, cognition, psychosocial sequelae and discharge planning. Role and internal characteristics impacted on service delivery. It is envisaged that earlier intervention in a greater percentage of patients, a greater evidence-base, raising awareness and adequate staffing will be features for future development. Originality/value This study provides new insight into the current role and practices of adult critical care occupational therapists in England and generates insights into their role in addressing physical and non-physical morbidity for this patient cohort. Findings are preliminary in nature; however, future research is warranted to evaluate the effectiveness of interventions.

Learning whilst working

2019 ◽  
Vol 61 (2) ◽  
pp. 187-200
Author(s):  
Norma D’Annunzio-Green ◽  
Paul Barron
Keyword(s):  
Human Resource ◽  
Learning Transfer ◽  
Academic Staff ◽  
Educational Interventions ◽  
Organisational Culture ◽  
Transfer Of Knowledge ◽  
Structured Interviews ◽  
Line Managers ◽  
Content Type ◽  
Work Related

Purpose The purpose of this paper is to examine student learner perceptions of benefits, barriers and enablers in learning whilst working, specifically focussing, on learning transfer from a university MSc in human resource management to students’ professional roles as human resource practitioners. Design/methodology/approach The study used in-depth semi-structured interviews with alumni of the programme who had graduated between one to three years previously. Findings The study found benefits (increased self-confidence, credibility and networking skills) as well as unanticipated challenges relating to individual learner characteristics, organisational culture and work-related support that hindered learning transfer. Research limitations/implications The study contributes to understanding the mechanisms required to support part-time learners on continuing vocational education programmes from a variety of stakeholders including students, their managers, their university and work colleagues, and academic staff. It highlights the benefits of activities designed to help students relate theory to practice and facilitate the transfer of knowledge between academic and practitioner environments. Practical implications The study highlights learner perspectives that are focussed on how organisational culture and line managers might play a more central role in influencing how people learn at work and facilitate the transfer of learning from formal educational interventions. Originality/value The study is valuable to academics and practitioners interested in improving learning transfer from formal educational to professional settings.

scholarly journals Exploring the implications of the influence of organisational culture on work-life balance practices

2017 ◽  
Vol 46 (3) ◽  
pp. 454-473 ◽  
Author(s):  
Toyin Ajibade Adisa ◽  
Chima Mordi ◽  
Ellis L.C. Osabutey
Keyword(s):  
Working Hours ◽  
Organisational Culture ◽  
Work Life ◽  
Sub Saharan Africa ◽  
Work Life Balance ◽  
Medical Doctors ◽  
Structured Interviews ◽  
Life Balance ◽  
Content Type ◽  
Work Related

Purpose Whilst significant evidence of western work-life balance (WLB) challenges exists, studies that explore Sub-Saharan Africa (SSA) are scarce. The purpose of this paper is to explore how organisational culture in Nigerian medical organisations influences doctors’ WLB and examine the implications of supportive and unsupportive cultures on doctors’ WLB. Design/methodology/approach The paper uses qualitative data gleaned from semi-structured interviews of 60 medical doctors across the six geo-political zones of Nigeria in order to elicit WLB challenges within the context of organisational culture. Findings The findings show that organisational culture strongly influences employees’ abilities to use WLB policies. Unsupportive culture resulting from a lack of support from managers, supervisors, and colleagues together with long working hours influenced by shift work patterns, a required physical presence in the workplace, and organisational time expectations exacerbate the challenges that Nigerian medical doctors face in coping with work demands and non-work-related responsibilities. The findings emphasise how ICT and institutions also influence WLB. Originality/value The paper addresses the underresearched SSA context of WLB and emphasises how human resource management policies and practices are influenced by the complex interaction of organisational, cultural, and institutional settings.

Organizational perspectives on implementing complex health interventions: clinical genomics in Australia

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Stephanie Best ◽  
Janet C. Long ◽  
Clara Gaff ◽  
Jeffrey Braithwaite ◽  
Natalie Taylor
Keyword(s):  
Implementation Science ◽  
Theoretical Domains Framework ◽  
Structured Interviews ◽  
Content Type ◽  
Clinical Genomics ◽  
Medical Speciality ◽  
Organizational Engagement ◽  
Organizational Barriers ◽  
Science Theory ◽  
Implementation Leadership

PurposeClinical genomics is a complex, innovative medical speciality requiring clinical and organizational engagement to fulfil the clinical reward promised to date. Focus thus far has been on gene discovery and clinicians’ perspectives. The purpose of this study was to use implementation science theory to identify organizational barriers and enablers to implementation of clinical genomics along an organizations’ implementation journey from Preadoption through to Adoption and Implementation.Design/methodology/approachWe used a deductive qualitative approach study design drawing on implementation science theory - (1) Translation Science to Population Impact Framework, to inform semi structured interviews with organizational decision-makers collaborating with Australian and Melbourne Genomics, alongside and (2) Theoretical Domains Framework (TDF), to guide data analysis.FindingsWe identified evolving organizational barriers across the implementation journey from Preadoption to Implementation. Initially the organizational focus is on understanding the value of clinical genomics (TDF code: belief about consequences) and setting the scene (TDF code: goals) before organizational (TDF codes: knowledge and belief about consequences) and clinician (TDF codes: belief about capability and intentions) willingness to adopt is apparent. Once at the stage of Implementation, leadership and clarity in organizational priorities (TDF codes: intentions, professional identity and emotion) that include clinical genomics are essential prerequisites to implementing clinical genomics in practice. Intuitive enablers were identified (e.g. ‘providing multiple opportunities for people to come on board) and mapped hypothetically to barriers.Originality/valueAttention to date has centred on the barriers facing clinicians when introducing clinical genomics into practice. This paper uses a combination of implementation science theories to begin to unravel the organizational perspectives of implementing this complex health intervention.

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