title: Constraint-induced movement therapy for the upper paretic limb in acute or sub-acute stroke: a systematic review.
abstract: Constraint-induced movement therapy is a commonly used intervention to improve upper limb function after stroke. However, the effectiveness of constraint-induced movement therapy and its optimal dosage during acute or sub-acute stroke is still under debate. To examine the literature on the effects of constraint-induced movement therapy in acute or sub-acute stroke. A literature search was performed to identify randomized, controlled trials; studies with the same outcome measure were pooled by calculating the mean difference. Separate quantitative analyses for high-intensity and low-intensity constraint-induced movement therapy were applied when possible. Five randomized, controlled trials were included, comprising 106 participants. The meta-analysis demonstrated significant mean differences in favor of constraint-induced movement therapy for the Fugl-Meyer arm, the Action Research Arm Test, the Motor Activity Log, Quality of Movement and the Grooved Pegboard Test. Nonsignificant mean difference in favor of constraint-induced movement therapy were found for the Motor Activity Log, Amount of Use. Separate analyses for high-intensity and low-intensity constraint-induced movement therapy resulted in significant favorable mean differences for low-intensity constraint-induced movement therapy for all outcome measures, in contrast to high-intensity constraint-induced movement therapy. This meta-analysis demonstrates a trend toward positive effects of high-intensity and low-intensity constraint-induced movement therapy in acute or sub-acute stroke, but also suggests that low-intensity constraint-induced movement therapy may be more beneficial during this period than high-intensity constraint-induced movement therapy. However, these results were based on a small number of studies. Therefore, more trials are needed applying different doses of therapy early after stroke and a better understanding is needed about the different time windows in which underlying mechanisms of recovery operate.
authors.affiliation: Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Rinske
authors.initials: R
authors.lastname: Nijland
authors.forename: Gert
authors.initials: G
authors.lastname: Kwakkel
authors.forename: Japie
authors.initials: J
authors.lastname: Bakers
authors.forename: Erwin
authors.initials: E
authors.lastname: van Wegen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001132:Arm / Q000503:physiopathology*; D026241:Exercise Movement Techniques / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008875:Middle Aged; D009473:Neuronal Plasticity; D010243:Paralysis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012107:Research Design; D012149:Restraint, Physical / Q000009:adverse effects / Q000379:methods; D020521:Stroke / Q000150:complications*; D019467:Subacute Care; D013997:Time Factors; D016896:Treatment Outcome