Development of a behaviour change intervention to increase the delivery of upper limb constraint-induced movement therapy programs to people with stroke and traumatic brain injury.

Purpose: Constraint-induced movement therapy (CIMT) is a recommended intervention for arm recovery after acquired brain injury but is underutilised in practice. The purpose of this study is to describe the development of a behaviour change intervention targeted at therapists, to increase delivery of CIMT. Methods: A theoretically-informed approach for designing behaviour change interventions was used including identification of which behaviours needed to change (Step 1), barriers and enablers that needed to be addressed (Step 2), and intervention components to target those barriers and enablers (Step 3). Data collection methods included file audits and therapist interviews. Quantitative data (file audits) were analysed using descriptive statistics. Qualitative data analysis (interviews) was informed by the Theoretical Domains Framework (TDF) and Behaviour Change Wheel. Results: Fifty two occupational therapists, physiotherapists and allied health assistants participated in focus groups (n = 7) or individual interviews (n = 6). Key barriers (n = 20) and enablers (n = 10) were identified across 11 domains of the TDF and perceived to influence CIMT implementation. The subsequent behaviour change intervention included training workshops, nominated team champions, community of practice meetings, three-monthly file audit feedback cycles, poster reminders and drop-in support during CIMT. Conclusion: This study describes the development of a behaviour change intervention to increase CIMT delivery by clinicians. Trial registration: Australian New Zealand Clinical Trials Registry, Trial ID: ACTRN12617001147370. IMPLICATIONS FOR REHABILITATION: Constraint induced movement therapy (CIMT) is a highly effective intervention for arm recovery after acquired brain injury, recommended in multiple clinical practice guidelines, yet delivery of CIMT is often not part of routine practice. The Behaviour Change Wheel, COM-B (capability, opportunity, motivation- behaviour) system and Theoretical Domains Framework (TDF) helped identify barriers and enablers to CIMT delivery by therapists, and design a theoretically-informed behaviour change intervention. The effect of the behaviour change intervention on therapists practice can now be evaluated to determine if it increases the delivery of CIMT more routinely in practice. [ABSTRACT FROM AUTHOR]