Invited Speaker Australian and New Zealand Stroke Organisation Conference 2025

Stroke survivor preferences for the delivery of constraint-induced movement therapy (CIMT) programs: A discrete choice experiment (122616)

Lauren J Christie 1 2 3 , Amber Salisbury 4 , Nicola Fearn 5 , Laura Jolliffe 6 7 , Rumbi Teramayi 8 , Amanda Patterson 8 9 , Mark W Parsons 8 10 11 , Alison Pearce 12 13
  1. Allied Health Research Unit, St Vincent's Health Network Sydney, Darlinghurst, NSW, Australia
  2. Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
  3. School of Allied Health, Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
  4. Manchester Centre for Health Economics, University of Manchester, Manchester, United Kingdom
  5. Discipline of Occupational Therapy, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
  6. Allied Health Research, Peninsula Health, Frankston, Victoria, Australia
  7. National Centre for Healthy Ageing, Frankston, Victoria, Australia
  8. Sydney Brain Centre, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
  9. Department of Occupational Therapy, Liverpool Hospital, Liverpool, NSW , Australia
  10. South West Sydney Clinical Campus, UNSW, Liverpool, NSW, Australia
  11. Department of Neurology, Liverpool Hospital, Liverpool, NSW, Australia
  12. The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
  13. Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia

Background and aim: Constraint induced movement therapy (CIMT) is a strongly recommended intervention in national stroke guidelines. However, CIMT remains underutilised in practice. Whilst therapist barriers to delivering CIMT have been explored, little is known about stroke survivor perspectives. This study aims to identify stroke survivor preferences for CIMT program delivery. 

Methods: Community-based stroke survivors, recruited through clinics and a survey panel, completed an online discrete choice experiment survey. Respondents answered 10 ‘choice’ questions, each time choosing between two therapy programs or the option to decline therapy. Each therapy program was described by the therapy mode (group vs 1:1), staffing (therapist vs student), location (hospital, telehealth, clinic, hybrid) exercise time, mitt wearing time, cost, recovery amount (small, moderate or large) and likelihood of improvement (30%, 50% or 70% of people see improvement). Analysis included conditional logit and latent class models and willingness to pay estimates.

Results: Overall, participants (n=221) indicated a strong preference for CIMT participation. They preferred therapy to be with an experienced therapist (p<0.05), less intense (p<0.01), with less mitt time (p<0.05), less costly (p<0.001), and more likely to be effective (p< 0.001). Surprisingly, therapy mode, location and amount of recovery were not significant. Participants were willing to pay $455 to participate in a CIMT program. Moving from the least to most favourable program implementation increased CIMT uptake from 19% to 89%.

Conclusion: We demonstrate the importance of program structure and delivery, over effectiveness, in CIMT uptake by stroke survivors, which can inform program design and patient education.