The constraint induced movement therapy: a systematic review of randomised controlled trials on the adult stroke patients.
OBJECTIVE
The aim of this study was to analyse the evidence of effectiveness on adult stroke patients of the Constraint Induced Movement Therapy (CIMT), an original rehabilitation method that consists in strongly encouraging patients to use the affected arm, mainly immobilising the unaffected arm.


METHODS
We only took into account the randomised controlled trials on CIMT where the experimental treatment was compared with a conventional treatment without any discrepancy of organization or session duration. As we could not measure the statistical significance of differences between treated and control patients, we compared their respective post-treatment percent changes and computed the minimal clinically important difference (MCID), defined as a change of at least 10% of the maximum score of the scale used.


RESULTS
The literature search found 13 randomised controlled trials (RCTs), 4 of which were excluded because they aimed at comparing different intensity of CIMT. The 9 RCTs finally included into the review applied the CIMT in either acute, subacute or chronic stroke patients and according to different modalities. Findings were positive in all studies, but the MCID was reached only in smaller ones, which may have been influenced by patients' characteristics.


CONCLUSIONS
Although all studies achieved positive results, it is impossible to draw any clear-cut conclusion on the effectiveness of the CIMT. The main limitations are the lack of homogeneity in the outcome measures used, the inadequacy of data provided and the small samples' size. Multicentre studies, using robust outcome measures and considering both motor- and sensory-disabled patients are needed.
Bonaiuti
D
D
Department of Rehabilitation, S. Gerardo Hospital, Monza, Milan, Italy. bonaiuti@katamail.com
Rebasti
L
L
Sioli
P
P
D000328:Adult; D001132:Arm; D005081:Exercise Therapy; D006801:Humans; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic; D012149:Restraint, Physical; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome