title: Effectiveness of constraint-induced movement therapy on activity and participation after stroke: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To examine the effect of constraint-induced movement therapy and modified constraint-induced movement therapy on activity and participation of patients with stroke (i.e. the effect of different treatment durations and frequency) by reviewing the results of randomized controlled trials.
  
  
  METHODS
  A systematic literature search was conducted in MEDLINE, CINAHL, EMBASE, PEDro, OTSeeker, CENTRAL and by manual search.
  
  
  METHODS
  Randomized controlled trials for patients over 18 years old with stroke and published in Finnish, Swedish, English or German were included. Studies were collected up to the first week in May 2011. The evidence was high, moderate, low or no evidence according to the quality of randomized controlled trial and the results of meta-analyses.
  
  
  RESULTS
  Search resulted in 30 papers reporting constraint-induced movement therapy, including 27 randomized controlled trials published between 2001 and 2011. Constraint-induced movement therapy practice for 60-72 hours over two weeks produced better mobility (i.e. ability to carry, move and handle objects) with high evidence compared to control treatment. Constraint-induced movement therapy for 20-56 hours over two weeks, 30 hours over three weeks and 15-30 hours over 10 weeks improved mobility of the affected upper extremity. However, with self-care as an outcome measure, only 30 hours of constraint-induced movement therapy practice over three weeks demonstrated an improvement.
  
  
  CONCLUSIONS
  Constraint-induced movement therapy and modified constraint-induced movement therapy proved to be effective on affected hand mobility and to some extent self-care on the World Health Organization's International Classification of Functioning, Disability and Health activity and participation component, but further studies are needed to find out the optimal treatment protocols for constraint-induced movement therapy.
authors: Department of Health Sciences, Gerontology Research Centre, University of Jyväskylä, Finland. sinikka.peurala@gmail.com
authors: Sinikka H
authors: SH
authors: Peurala
authors: Mari P
authors: MP
authors: Kantanen
authors: Tuulikki
authors: T
authors: Sjögren
authors: Jaana
authors: J
authors: Paltamaa
authors: Maarit
authors: M
authors: Karhula
authors: Ari
authors: A
authors: Heinonen
mesh_terms: D000203:Activities of Daily Living; D026241:Exercise Movement Techniques / Q000379:methods*; D005260:Female; D005387:Finland; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D010358:Patient Participation; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012149:Restraint, Physical / Q000009:adverse effects; D018570:Risk Assessment; D012648:Self Care; D020521:Stroke / Q000150:complications / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity