An effectiveness-implementation trial of home-based early hand therapy for young children with cerebral palsy

BACKGROUND: Early hand therapy is an effective approach for improving hand function in young children with cerebral palsy (CP), yet clinical implementation is limited. This trial assessed implementation and effectiveness of a high dose early hand therapy. METHODS: A home-based, caregiver-delivered intervention of 18-weeks with daily 30-minute practice (60 h total) of constraint-induced movement therapy and bimanual therapy. A coaching approach was used to support caregivers, with weekly coaching sessions provided in-person or virtually. Implementation strategies included training, educational materials, and dedicated clinician time. The primary effectiveness outcome was achievement of individualized hand function goals, assessed via the Canadian Occupational Performance Measure (COPM) pre/post/8-weeks post-intervention. The primary implementation outcome was satisfaction assessed by caregivers and clinicians post-intervention. A repeated measures ANOVA assessed change in COPM scores, with Bonferroni correction of post hoc pairwise comparisons (paired t-tests). Mean values and standard deviations (SD) were calculated for satisfaction scores. RESULTS: Eighteen participants completed the protocol, aged 4-22 months (mean 13, SD 6 months). COPM scores significantly improved from pre- to post-intervention (p < 0.001) and pre- to 8-weeks post-intervention (p < 0.001). Mean satisfaction scores indicated a large to very large extent of satisfaction for caregivers (4.9/5.0, SD 0.3) and for clinicians (4.5/5.0, SD 0.6). CONCLUSIONS: Implementation of a caregiver-delivered home-based early hand therapy was highly satisfactory and effective for achievement of individualized hand function goals. Resources are available to support implementation spread.