Clinical utility of a decision-making aid for upper limb neurorehabilitation: applying the Hypertonicity Intervention Planning Model across cultures

Abstract

ABSTRACT Background The Hypertonicity Intervention Planning Model (HIPM) is a decision-making aid which guides clinical reasoning in individualizing upper limb (UL) neurorehabilitation. Aim To examine the HIPM’s clinical utility across cultures, using therapists’ perceptions of its usefulness and challenges when applied in clinical practice. Methods Interpretive description methodology guided qualitative data collection and analysis because it produces clinically practical applications. Forty-four occupational therapists working in Australia or Singapore participated. Three group discussions were conducted using a modified nominal group technique. Results Three themes were: (1) The HIPM guides systematic clinical decision-making for assessment, goal-setting, and intervention; (2) Utility was influenced by systemic or organizational supports and barriers including availability of time, resources, and funding; organizational readiness to change; multidisciplinary and transorganizational collaboration; (3) Therapists’ skills and confidence to apply the HIPM, and openness to changing practice, influenced utility. Conclusions Therapists strongly support HIPM use for structuring and communicating clinical reasoning in UL neurorehabilitation. However, organizational support is key to optimizing clinical utility. Incorporating decision-making aids into documentation and referral processes may strengthen multidisciplinary and transorganizational teamwork, enhancing clinical use. Different training tiers to suit therapist experience levels, refresher courses, and supplementary resources may improve therapists’ skills and confidence, thereby boosting utility.