Knowledge and perception of occupational therapists and physiotherapists on the use of constraint-induced movement therapy for stroke rehabilitation in South Africa

INTRODUCTION

Most stroke survivors have upper extremity (UE) impairment early after stroke¹. The prevalence of upper extremity impairment is approximately 50-80% in the acute phase and 40-50% in the chronic phase². Impairment of the UE can cause significant difficulties for patients recovering from stroke as it affects all areas of occupation. In clinical practice, occupational therapists and physiotherapists are expected to manage UE impairment after stroke and carry out treatment approaches that will effectively rehabilitate the UE. Yet, the treatment approaches for managing these difficulties in South Africa have not been widely reviewed.

After a stroke, several approaches exist for UE motor function rehabilitation. Constraint-induced movement therapy (CIMT) is a commonly used rehabilitation approach to improve upper extremity function (e.g., hemiparesis) after a stroke. In CIMT, the less affected UE is restrained while the affected UE receives intensive training in unimanual skills and the fine motor skills of the affected UE improve significantly after intervention³. CIMT has been shown to improve motor function in chronic hemiparesis of stroke patients⁴. In chronic patients with mild to moderate hemiparesis, the CIMT rehabilitation approach has been used for improving the motor recovery of the affected UE^4,5. Following a stroke, the patient starts to compensate due to difficulty using the affected limb, relying increasingly on the unaffected limb, and this compensation will result in learned non-use⁶. Although CIMT is regarded as the most effective approach to facilitating UE recovery following stroke, it has also not been used frequently for neurological rehabilitation by therapists⁵.

In South Africa, the absolute number of persons affected by stroke has increased yearly since 1990, along with the number of disabled stroke survivors⁷. The use of the CIMT treatment approach could be valuable in treating UE impairment; however, its application within the South African context is not well documented. Knowledge and perception of the use of CIMT for stroke rehabilitation are reported to directly affect the therapist-patient interaction, competence in carrying out the necessary intervention, and preferred therapy approach when providing treatment⁶. The study investigated the knowledge and perceptions of South African occupational therapists and physiotherapists on the utilisation of CIMT for UE rehabilitation in stroke patients....