LAUSR

Keywords: Virtual;CIMT;Service Purpose: Upper limb weakness is a common complaint post stroke. Motor impairment and learned non-use can lead to secondary complications such as muscle atrophy, weakness, stiffness and contractures, which reduce function. Constraint induced movement therapy (CIMT) is a daily intensive rehabilitation treatment for upper limb weakness post stroke shown to improve activity of the weaker limb by constraining the non-affected hand and undertaking repetitive task and motor learning exercises. However CIMT is sometimes difficult to implement due to the length of time of the programme (daily attendance for 2–3 weeks) and the therapy staff and time needed. COVID-19 and the global pandemic halted face to face therapy and our aim was to redesign and deliver CIMT virtually. The objective was to consider the practicalities of virtual programmes and use patient reported outcomes to determine any difference between virtual and face to face. Methods: From September 2020 to March 2021 patients referred for CIMT were assessed using established criteria. Programmes were individually tailored to include daily supervised and independent practice. The virtual programme was established to align with the face to face programme as closely as possible. The main requirements for the virtual programme were patients’ acceptance and ability to undertake a virtual programme and access to technology that supported video consultation. Patients were supported via email/telephone and a member of the therapy team monitored progress daily in a 45 min video consultation. The ArmA (Arm Activity Measure) was completed pre and post programme for both virtual and face to face. ArmA consists of two parts;ArmA-A asks whether the patient is able to care for their arm themselves or with a carer and ArmA-B asks how easy or hard it is to use their affected arm in functional tasks. Lower scores indicate better ability. Results: Four patients completed a CIMT programme face to face and 6 virtually. ArmA scores for the whole group pre CIMT;ArmA-A, range 1–18 (maximum score 32) and ArmA-B, range 8–43 (maximum score 52). Post CIMT;ArmA-A range 0–15 with 4 patients scoring 0 or 1 and ArmA-B range 4–31. Virtual versus face to face ArmA scores reduced in both groups with change scores of between 4–14 points on ArmA-A and 3–22 points on ArmA-B. Conclusion(s): This is a small service evaluation of CIMT delivery methods in an outpatient service. Both groups showed improvements in caring for and functional use of their arm. Patients found CIMT delivered virtually or face to face as acceptable and all adhered to the programme. Impact: There are clear advantages to virtually delivered therapy programmes with the impact of flexibility and choice for patients and a ‘Greener NHS’ service due to decreased daily travel and reduction in carbon footprint that could transform physiotherapy practice and contribute to greater accessibility for many. Services that have been traditionally thought of as face to face delivery are showing commensurate benefit that needs further evaluation and research. Funding acknowledgements: No funding received.