title: The EXCITE stroke trial: comparing early and delayed constraint-induced movement therapy.
abstract: OBJECTIVE
  Although constraint-induced movement therapy (CIMT) has been shown to improve upper extremity function in stroke survivors at both early and late stages after stroke, the comparison between participants within the same cohort but receiving the intervention at different time points has not been undertaken. Therefore, the purpose of this study was to compare functional improvements between stroke participants randomized to receive this intervention within 3 to 9 months (early group) to participants randomized on recruitment to receive the identical intervention 15 to 21 months after stroke (delayed group).
  
  
  METHODS
  Two weeks of CIMT was delivered to participants immediately after randomization (early group) or 1 year later (delayed group). Evaluators blinded to group designation administered primary (Wolf Motor Function Test, Motor Activity Log) and secondary (Stroke Impact Scale) outcome measures among the 106 early participants and 86 delayed participants before delivery of CIMT, 2 weeks thereafter, and 4, 8, and 12 months later.
  
  
  RESULTS
  Although both groups showed significant improvements from pretreatment to 12 months after treatment, the earlier CIMT group showed greater improvement than the delayed CIMT group in Wolf Motor Function Test Performance Time and the Motor Activity Log (P<0.0001), as well as in Stroke Impact Scale Hand and Activities domains (P<0.0009 and 0.0214, respectively). Early and delayed group comparison of scores on these measures 24 months after enrollment showed no statistically significant differences between groups.
  
  
  CONCLUSIONS
  CIMT can be delivered to eligible patients 3 to 9 months or 15 to 21 months after stroke. Both patient groups achieved approximately the same level of significant arm motor function 24 months after enrollment. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00057018.
authors.affiliation: Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Ga 30322, USA. swolf@emory.edu
authors.forename: Steven L
authors.initials: SL
authors.lastname: Wolf
authors.forename: Paul A
authors.initials: PA
authors.lastname: Thompson
authors.forename: Carolee J
authors.initials: CJ
authors.lastname: Winstein
authors.forename: J Phillip
authors.initials: JP
authors.lastname: Miller
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Blanton
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Nichols-Larsen
authors.forename: David M
authors.initials: DM
authors.lastname: Morris
authors.forename: Gitendra
authors.initials: G
authors.lastname: Uswatte
authors.forename: Edward
authors.initials: E
authors.lastname: Taub
authors.forename: Kathye E
authors.initials: KE
authors.lastname: Light
authors.forename: Lumy
authors.initials: L
authors.lastname: Sawaki
mesh_terms: D000368:Aged; D001132:Arm / Q000503:physiopathology; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome
references.citation: NeuroRehabilitation. 2002;17(3):215-24
references.pmid: 12237502
references.citation: Neurorehabil Neural Repair. 2007 Jan-Feb;21(1):3-13
references.pmid: 17172549
references.citation: Neurorehabil Neural Repair. 2003 Sep;17(3):137-52
references.pmid: 14503435
references.citation: J Neurosci. 2004 Feb 4;24(5):1245-54
references.pmid: 14762143
references.citation: Neurology. 2006 Oct 10;67(7):1189-94
references.pmid: 17030751
references.citation: Rev Recent Clin Trials. 2006 Jan;1(1):75-80
references.pmid: 18393783
references.citation: Prog Neurobiol. 2004 May;73(1):61-72
references.pmid: 15193779
references.citation: Neurol Res. 2008 Jun;30(5):504-10
references.pmid: 18953741
references.citation: Nat Rev Neurosci. 2002 Mar;3(3):228-36
references.pmid: 11994754
references.citation: Scand J Rehabil Med. 1975;7(1):13-31
references.pmid: 1135616
references.citation: Brain Res. 1998 Feb 9;783(2):286-92
references.pmid: 9507166
references.citation: Arch Phys Med Rehabil. 1993 Apr;74(4):347-54
references.pmid: 8466415
references.citation: Stroke. 2000 Jun;31(6):1210-6
references.pmid: 10835434
references.citation: Arch Phys Med Rehabil. 2003 Jul;84(7):950-63
references.pmid: 12881816
references.citation: Stroke. 2008 May;39(5):1520-5
references.pmid: 18323492
references.citation: Exp Brain Res. 2006 Feb;169(1):106-16
references.pmid: 16273404
references.citation: Soc Sci Med. 1999 Jun;48(11):1507-15
references.pmid: 10400253
references.citation: JAMA. 2006 Nov 1;296(17):2095-104
references.pmid: 17077374
references.citation: Circulation. 2008 Jan 29;117(4):e25-146
references.pmid: 18086926
references.citation: Neurorehabil Neural Repair. 2008 Sep-Oct;22(5):505-13
references.pmid: 18780885
references.citation: Neurorehabil Neural Repair. 2007 Sep-Oct;21(5):379-87
references.pmid: 17644651
references.citation: Arch Phys Med Rehabil. 2007 Mar;88(3):273-8
references.pmid: 17321816
references.citation: Stroke. 2001 Jul;32(7):1635-9
references.pmid: 11441212
references.citation: Lancet Neurol. 2008 Jan;7(1):33-40
references.pmid: 18077218
references.citation: Stroke. 2006 Apr;37(4):1045-9
references.pmid: 16514097
references.citation: Stroke. 2006 Jun;37(6):1552-5
references.pmid: 16645139
references.citation: J Speech Lang Hear Res. 1998 Feb;41(1):172-87
references.pmid: 9493743
references.citation: Neurology. 2009 Jul 21;73(3):195-201
references.pmid: 19458319
references.citation: Neurorehabil Neural Repair. 2005 Mar;19(1):27-32
references.pmid: 15673841
references.citation: Stroke. 1999 Oct;30(10):2131-40
references.pmid: 10512918