Evidence map›Paper›PMID 40186231›Full record

ArticleBMC health services research2025

Facilitators and barriers to implementation of early intensive manual therapies for young children with cerebral palsy across Canada.

Divya Vurrabindi, Alicia J Hilderley, Adam Kirton, John Andersen, Christine Cassidy, Shauna Kingsnorth, Sarah Munce, Brenda Agnew, Liz Cambridge, Mia Herrero and 9 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Divya VurrabindiBloorview Research Institute, Rehabilitation Sciences Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada.
Alicia J HilderleyUniversity of Calgary, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
Adam KirtonDepartment of Pediatrics, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
John AndersenDepartment of Pediatrics, University of Alberta, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada.
Christine CassidySchool of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
Shauna KingsnorthDepartment of Occupational Science & Occupational Therapy, Rehabilitation Sciences Institute, Bloorview Research Institute, Teaching & Learning Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada.
Sarah MunceInstitute of Health Policy, Management and Evaluation, Rehabilitation Sciences Institute, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, Canada.
Brenda AgnewCHILD-BRIGHT Network, Quebec, Canada.
Liz CambridgeHolland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.
Mia HerreroAlberta Children's Hospital, Calgary, AB, Canada.
Eleanor LeveringtonAlberta Health Services, Calgary, AB, Canada.
Susan McCoyHolland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.
Victoria MicekGlenrose Rehabilitation Hospital, Edmonton, AB, Canada.
Keith O ConnorBC Children's Hospital, Vancouver, BC, Canada.
Kathleen O' GradyGlenrose Rehabilitation Hospital, Edmonton, AB, Canada.
Sandra Reist-AsencioAlberta Children's Hospital, Calgary, AB, Canada.
Chelsea TaoGlenrose Rehabilitation Hospital, Edmonton, AB, Canada.
Stephen TaoGlenrose Rehabilitation Hospital, Edmonton, AB, Canada.
Darcy FehlingsDepartment of Paediatrics, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, 150 Kilgour Rd, Toronto, ON, M4G 1R8, Canada. dfehlings@hollandbloorview.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCerebral Palsy (CP) is the most common childhood-onset motor disability. Play-based early intensive manual therapies (EIMT) is an evidence-based practice to improve long-term hand function particularly for children with asymmetric hand use due to CP. For children under two years old, this therapy is often delivered by caregivers who are coached by occupational therapists (OTs). However, why only a few Canadian sites implement this therapy is unclear. There is a need to identify strategies to support implementation of EIMT. The primary objective of this study was to identify the facilitators and barriers to EIMT implementation from the perspectives of (1) caregivers of children with CP (2), OTs and (3) healthcare administrators for paediatric therapy programs.

methodsThe Consolidated Framework for Implementation Research (CFIR) was used to guide development of an online 5-point Likert scale survey to identify facilitators (scores of 4 and 5) and barriers (scores of 1 and 2) to implementation of EIMT. Three survey versions were co-designed with knowledge user partners for distribution to caregivers, OTs, and healthcare administrators across Canada. The five most frequently endorsed facilitators and barriers were identified for each respondent group.

resultsFifteen caregivers, 54 OTs, and 11 healthcare administrators from ten Canadian provinces and one territory participated in the survey. The majority of the identified facilitators and barriers were within the 'Inner Setting' CFIR domain, with 'Structural Characteristics' emerging as the most reported CFIR construct. Based on the categorization of the most frequently endorsed facilitators and barriers within the CFIR domains, the key facilitators to EIMT implementation included the characteristics of the intervention and establishing positive workplace relationships and culture. The key barriers included having workplace restrictions on EIMT delivery models and external influences (e.g., funding) on EIMT uptake.

conclusionsWe identified key facilitators and barriers to implementing EIMT from a multi-level Canadian context. These findings will inform the next steps of designing evidence-informed and theory-driven implementation strategies to support increased delivery of EIMT for children under two years old with asymmetric hand use due to CP across Canada.

Indexed as

Cerebral PalsyMusculoskeletal ManipulationsCanadaCaregiversChild, PreschoolFemaleHumansInfantMaleOccupational TherapySurveys and QuestionnairesBimanual therapyConsolidated framework for implementation researchConstraint induced movement therapyEarly interventionHemiplegic cerebral palsyImplementationSurvey research

Identifiers

PMID40186231
PMCPMC11971912

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.