BMJ paediatrics open · 2025
Partnership delivery of evidence-based therapy intervention to improve upper-limb function: a retrospective analysis.
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Massey Jill, Dreyer Leanne Claire, Molteni Erika, Siegle Ben, Arichi Tomoki, Gordon Anne
Аннотация
OBJECTIVE: To describe clinical characteristics and outcomes of children and young people with hemiplegia completing a novel dedicated therapy intervention, 'Evelina REACH'. This evidence-based upper-limb outpatient intervention is delivered in partnership with the child, caregivers, and occupational therapists at a tertiary hospital and community allied health professionals.
DESIGN: Retrospective audit of patients completing a 6-week protocolised therapy intervention with repeated standardised measures of spontaneous arm and hand use and of caregiver goal rating.
SETTING: A tertiary level children's hospital in London, UK.
PATIENTS: 156 children (median age 26 months, range 4 months-16.5 years) completing a therapy intervention programme between 2012 and 2023.
INTERVENTIONS: An intensive, protocolised and individualised goal-directed therapy intervention programme, co-delivered by the patient, caregivers and hospital-based and community therapists.
MAIN OUTCOME MEASURES: Assisting Hand Assessment (AHA), Goal Attainment Scaling (GAS)/Goal Attainment Scaling Light and Canadian Occupational Performance Measure (COPM).
RESULTS: Clinically significant gains were achieved with a mean AHA logit score change of 7 (n=69) which was maintained at 6 weeks post intervention (n=35). At least 1 GAS goal was met or exceeded by 99.2% participants, with measurable score change across three caregiver-mediated COPM goals, performance=90.17%, and satisfaction=83.58%. Of caregivers surveyed, 97.85% would repeat the programme, and 100% would recommend it to others.
CONCLUSIONS: Evelina REACH is a clinically effective, goal-directed intensive activity-based therapy intervention that fosters lasting functional improvements in upper-limb use. Further research should explore optimal and scalable co-delivery models to enhance children's access to evidence-based therapy in statutory healthcare.
DESIGN: Retrospective audit of patients completing a 6-week protocolised therapy intervention with repeated standardised measures of spontaneous arm and hand use and of caregiver goal rating.
SETTING: A tertiary level children's hospital in London, UK.
PATIENTS: 156 children (median age 26 months, range 4 months-16.5 years) completing a therapy intervention programme between 2012 and 2023.
INTERVENTIONS: An intensive, protocolised and individualised goal-directed therapy intervention programme, co-delivered by the patient, caregivers and hospital-based and community therapists.
MAIN OUTCOME MEASURES: Assisting Hand Assessment (AHA), Goal Attainment Scaling (GAS)/Goal Attainment Scaling Light and Canadian Occupational Performance Measure (COPM).
RESULTS: Clinically significant gains were achieved with a mean AHA logit score change of 7 (n=69) which was maintained at 6 weeks post intervention (n=35). At least 1 GAS goal was met or exceeded by 99.2% participants, with measurable score change across three caregiver-mediated COPM goals, performance=90.17%, and satisfaction=83.58%. Of caregivers surveyed, 97.85% would repeat the programme, and 100% would recommend it to others.
CONCLUSIONS: Evelina REACH is a clinically effective, goal-directed intensive activity-based therapy intervention that fosters lasting functional improvements in upper-limb use. Further research should explore optimal and scalable co-delivery models to enhance children's access to evidence-based therapy in statutory healthcare.