{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T10:38:55Z","timestamp":1785494335417,"version":"3.56.0"},"reference-count":56,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,7,9]],"date-time":"2023-07-09T00:00:00Z","timestamp":1688860800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aus Occup Therapy J"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Strong evidence supports the provision of modified constraint\u2010induced movement therapy (mCIMT) to improve upper limb function after stroke. A service audit identified that very few patients received mCIMT in a large subacute, early\u2010supported discharge rehabilitation service. A behaviour change intervention was developed to increase the provision of mCIMT following an unsuccessful \u2018education only\u2019 attempt. This paper aims to systematically document the steps undertaken and to provide practical guidance to clinicians and rehabilitation services to implement this complex, yet effective, rehabilitation intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This clinician behaviour change intervention was developed over five stages and led by a working group of neurological experts (<jats:italic>n<\/jats:italic>\u2009=\u20093). Data collection methods included informal discussions with clinicians and an online survey (<jats:italic>n<\/jats:italic>\u2009=\u200935). The staged process included reflection on why the first attempt did not improve the provision of mCIMT (stage 1), mapping barriers and enablers to the Theoretical Domains Framework (TDF) and behaviour change wheel (BCW) to guide the behaviour change techniques (stages 2 and 3), developing a suitable mCIMT protocol (stage 4), and delivering the behaviour change intervention (stage 5).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Reflection among the working group identified the need for upskilling in mCIMT delivery and the use of a behaviour change framework to guide the implementation program. Key determinants of behaviour change operated within the TDF domains of knowledge, skills, environmental context and resources, social role and identity, and social influences. Following the development of a context\u2010specific mCIMT protocol, the BCW guided the behaviour change intervention, which included education, training, persuasion, environmental restructuring, and modelling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This paper provides an example of using the TDF and BCW to support the implementation of mCIMT in a large early\u2010supported discharge service. It outlines the suite of behaviour change techniques used to influence clinician behaviour. The success of this behaviour change intervention will be explored in future research.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1440-1630.12896","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T05:44:35Z","timestamp":1688967875000},"page":"661-677","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Unlocking the restraint\u2014Development of a behaviour change intervention to increase the provision of modified constraint\u2010induced movement therapy in stroke rehabilitation"],"prefix":"10.1111","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2949-3385","authenticated-orcid":false,"given":"Ashan","family":"Weerakkody","sequence":"first","affiliation":[{"name":"Rehabilitation in the Home, South Metropolitan Health Service Department of Health  Fremantle Australia"},{"name":"School of Medical and Health Sciences Edith Cowan University  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn","family":"Emmanuel","sequence":"additional","affiliation":[{"name":"Rehabilitation in the Home, South Metropolitan Health Service Department of Health  Fremantle Australia"},{"name":"Neurotherapy Occupational Therapy Services  Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn","family":"White","sequence":"additional","affiliation":[{"name":"Rehabilitation in the Home, South Metropolitan Health Service Department of Health  Fremantle Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Godecke","sequence":"additional","affiliation":[{"name":"School of Medical and Health Sciences Edith Cowan University  Perth Australia"},{"name":"Sir Charles Gairdner Hospital, North Metropolitan Health Service Department of Health  Nedlands Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barby","family":"Singer","sequence":"additional","affiliation":[{"name":"School of Medical and Health Sciences Edith Cowan University  Perth Australia"},{"name":"TRAining Centre in Subacute Care (TRACSWA) Department of Health  Fremantle Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0605-9"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(15)00147-7"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-018-0836-4"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3109\/21679169.2015.1078843"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2009.11.009"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-0312"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-7-37"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1440-1630.12567"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1108\/JHOM-07-2020-0297"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1017\/BrImp.2022.18"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269215518765329"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-015-0223-3"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004433.pub3"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-50"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1310\/tsr1903-268"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-022-02104-1"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/1747493019873597"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.3138\/ptc.2012-61"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1310\/tsr2104-319"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-7-35"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-7-38"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.502229"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/chp.47"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119488620.ch11"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119488620.ch10"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1687"},{"key":"e_1_2_11_28_1","unstructured":"Jarvis K.(2016).Occupational therapy for the upper limb after stroke: Implementing evidence\u2010based constraint induced movement therapy into practice. (Doctor of Philosophy). Keele University Retrieved fromhttps:\/\/eprints.keele.ac.uk\/2412\/"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-008592"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(14)70160-7"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968318777844"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-018-3671-z"},{"key":"e_1_2_11_33_1","unstructured":"Massie L. Gibson G. Vandenberg A. &McCluskey A.(2014).Modified constraint induced movement therapy (mCIMT) program: Participant workbook[2]. Retrieved fromhttp:\/\/strokeed.com\/resource-collection\/"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/1440-1630.12647"},{"key":"e_1_2_11_35_1","volume-title":"How to do constraint\u2010induced movement therapy","author":"Meharg A.","year":"2015"},{"key":"e_1_2_11_36_1","volume-title":"The behaviour change wheel: A guide to designing interventions","author":"Michie S.","year":"2014"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-42"},{"issue":"3","key":"e_1_2_11_38_1","first-page":"257","article-title":"Constraint\u2010induced movement therapy: Characterizing the intervention protocol","volume":"42","author":"Morris D.","year":"2006","journal-title":"Europa Medicophysica"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2019.1587013"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-021-01178-0"},{"key":"e_1_2_11_41_1","unstructured":"National Institute for Health and Care Excellence (NICE). (2013).Stroke rehabilitation in adults. Retrieved fromwww.nice.org.uk\/guidance\/cg162"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(03)00481-7"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2013.08.240"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-024950"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43058-022-00315-0"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269215519848813"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2019.1597178"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/jep.13715"},{"key":"e_1_2_11_49_1","unstructured":"Stroke Foundation (Producer). (2022 16\/11\/2022).Living Clinical Guidelines for Stroke Management. Retrieved fromhttps:\/\/informme.org.au\/guidelines\/living\u2010clinical\u2010guidelines\u2010for\u2010stroke\u2010management"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03392276"},{"key":"e_1_2_11_51_1","volume-title":"UAB training for CI therapy","author":"Taub E.","year":"2011"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.000559"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.3109\/0142159X.2013.828153"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1177\/1747493019897843"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1310\/tsr1902-104"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-4949.2012.00974.x"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2017.06.014"}],"container-title":["Australian Occupational Therapy Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1440-1630.12896","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T08:31:35Z","timestamp":1702974695000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1440-1630.12896"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,9]]},"references-count":56,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1111\/1440-1630.12896"],"URL":"https:\/\/doi.org\/10.1111\/1440-1630.12896","archive":["Portico"],"relation":{},"ISSN":["0045-0766","1440-1630"],"issn-type":[{"value":"0045-0766","type":"print"},{"value":"1440-1630","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,9]]},"assertion":[{"value":"2022-11-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}