Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
This proposal will present and review data from a fidelity-of-intervention tool currently used to evaluate the fidelity of implementation in pediatric constraint-induced movement therapy (pCIMT). Measuring treatment fidelity in OT environments will allow therapists to translate core components of therapies that have been scientifically validated as efficacious. This is critical for pCIMT as it is widely used in the treatment of children with hemiparesis across clinical settings
Primary Author and Speaker: Megan D. Price
Contributing Authors: Stephanie DeLuca, Sharon Landesman Ramey, Amy Darragh, and Rich Stevenson
PURPOSE: Pediatric Constraint Induced Movement Therapy (pCIMT) is a highly-researched treatment used for the treatment of children with hemiparesis to help them gain function and skill. There are many variations in pCIMT treatment protocols in the literature that have demonstrated treatment efficacy and no single protocol has been identified as ‘best practice'. The signature form of pCIMT was defined by Ramey et al, in 2013 as having 5 core components as crucial to ensure maximal chance of treatment efficacy. These 5 components include: constraint of the uninvolved arm; treatment delivered at a high dose meaning many hours a day for multiple days across multiple weeks; the use of operant conditioning during treatment; treatment in naturalistic settings; and the use of a post-treatment transition plan. A pCIMT treatment fidelity tool was recently developed to measure these core components, and this project assessed the fidelity of treatment implementation across several different pCIMT protocols via scoring of video tape and in reviewing pCIMT protocols in the literature. Methodology: We scored 36 video recordings of pCIMT sessions across multiple protocols meeting the definition of the signature form of pCIMT with a pCIMT treatment fidelity of intervention tool. The tool dichotomously measures the 5 core components of pCIMT plus two additional components which include the delivery of pCIMT by a trained professional and the use of parent education during pCIMT. Operant conditioning for pCIMT is then additionally scored via a 3-point rating scale of 6 requirements known to be important for successful learning during operant conditioning. These items focus on movement initiation and task selection, the use of appropriately timed reinforcement, repetition, and refinement of tasks. The tool yields a composite score of 6-18. To be considered as meeting acceptable fidelity to the core components of pCIMT activities on the video must have a score > 12. Anything < 12 is considered as not meeting pCIMT standards. In addition, we reviewed 128 articles on pCIMT to examine if the authors reported on the 5 core components of pCIMT.
RESULTS: Twenty-two videos scored between 12 and 18 on the operant conditioning portion of the pCIMT fidelity of implementation tool. Fourteen video segments scored below 12. Of the 128 articles reviewed 95% reported the type of constraint used; 45% reported the dosage of treatment; 27% reported if operant conditioning occurred during treatment activities; 50% reported if treatment occurred in naturalistic settings; 50% reported using a transition post-treatment plan; 45% reported that therapists were trained in pCIMT; and 50% reporting using parent education during pCIMT.
CONCLUSIONS: Our findings suggest that delivery of treatment can vary even among highly trained individuals with well-developed and highly researched protocols. This suggests that measuring treatment fidelity is crucial to translating evidenced-based treatments, such as pCIMT. Protocol replication is key to maximizing treatment benefit for clients and to continuing to promote evidenced-based practice.
References
Ramey, S.L., Coker-Bolt, P., DeLuca, S.C., (2013). Handbook of Pediatric Constraint-Induced Movement Therapy (CIMT): A Guide for Occupational Therapy and Health Care Clinicians, Researchers, and Educators. The American Occupational Therapy Assoc, Inc.
DeLuca, S. C., Ramey, S. L., Trucks, M. R., & Wallace, D. A. (2015). Multiple treatments of pediatric constraint-induced movement therapy (pCIMT): A clinical cohort study. American Journal of Occupational Therapy, 69, 6906180010. http://dx.doi.org/10.5014/ajot.2015.019323
DeLuca, S. C., Case-Smith, J., Stevenson, R., & Ramey, S. (2012). Constraint-induced movement therapy (CIMT) for young children with cerebral palsy: Effects of therapeutic dosage. Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach, 5, 133-142. https://doi.org/10.3233/PRM-2012-0206
Novak, I., McIntyre, S., Morgan, C., Campbell, L., Dark, L., Morton, N., Goldsmith, S. (2013). A systematic review of interventions for children with cerebral palsy: state of the evidence. Developmental Medicine & Child Neurology, 55, 885-910. https://doi.org/10.1111/dmcn.12246
