Abstract

Introduction: Modified constraint-induced movement therapy (mCIMT) has a good level of evidence for upper limb (UL) recovery. However, there is limited information on the strategies used to ensure adequate adherence to the protocol at home; detailed guidelines with activities and resources are needed to increase adherence and ensure safe and effective implementation. In our Hospital, mCIMT is applied following a locally created approach called Functional Activity Practice (FAP) Wich ncludes: sensory stimulation, preparatory tasks and functional activity according to the sensorimotor level of the patient; and in the present clinical trial it is combined with transcranial direct current stimulation (tDCS). Objective: To evaluate adherence to a combined mCIMT (with PAF approach) and tDCS protocol, which includes detailed home guidance. Methods: As part of an ongoing randomized controlled trial, 38 patients are randomized to receive 20 or 30 minutes of tDCS combined with mCIMT, a multicomponent guide with home strategies was generated. ClinicalTrials.gov ID: NCT06396715 The guide (Figure 2) integrates three core pillars to ensure adherence and safety in the home setting: mCIMT Protocol & Resources, which supplies the restraint glove, a therapeutic kit, and customized instructions (written and audiovisual) based on the Functional Activity Practice (FAP) approach; Education, comprising initial training for patients and caregivers on safety and assistance levels Monitoring, consisting of twice-weekly telephone follow-ups to assess glove usage, activity compliance, and pain levels (NPRS) Results: 28 patients have entered the clinical trial, with 193 telephone follow-ups to date. 83% reported using the glove at home, averaging 90 minutes per day, with "lack of time" being the main reason for non-use (55%). 90% percent completed the assigned activity protocol. 11 patients reported pain during activities, with a mean of 3 (NPRS) and most frequently in the shoulder and associated with a prior musculoskeletal conditions. Only one patient reported difficulties in performing the activities (Figure 3). Conclusion: providing a multicomponent home care guide that includes therapeutic materials, written instructions, and audiovisual support has led to a good level of adherence to glove use and the performance of assigned activities, making its use feasible and beneficial for occupational therapists who use mCIMT protocols in their clinical practice. Although the daily glove usage time was lower than recommended, we believe that the 95 minutes of use along with the implementation of the PAF approach supported the motor and functional recovery process of the UL.