title: Barriers to the implementation of constraint-induced movement therapy into practice.
abstract: OBJECTIVE
  Constraint-induced movement therapy (CIMT) has been studied for many years in the treatment of the hemiplegic upper extremity (UE). However, there has been limited adoption of the protocol in daily practice.
  
  
  METHODS
  In this article, we review the CIMT literature specifically for meta-analysis, randomized controlled trials (RCTs), recent case reports, case series, and pilot studies of CIMT in the adult poststroke population to identify barriers to implementation.
  
  
  RESULTS
  The following barriers have been identified: (a) limited generalizability, (b) resource intensity, (c) therapist factors, (d) patient factors, and (e) uncertainty regarding the emerging debate that the gains seen may be a result of intense, task-specific therapy focused on the use of the more affected UE and not specific to the protocol.
  
  
  CONCLUSIONS
  CIMT has positive outcomes in the treatment of a select group of stroke survivors. Many national guidelines of stroke rehabilitation recommend that CIMT be used when appropriate, however adoption into practice has been limited. The issue of generalizability is being addressed by expanding protocol application to other populations. Resource intensity, with respect to cost and therapist time, is a major concern and has lead to the development of novel modes of service delivery. The benefit seen with CIMT may actually be the result of exposure to intense, task-specific therapy with a focus on the use of the more affected UE, but more research into this area is needed.
authors.affiliation: Department of Physical Medicine and Rehabilitation, St. Joseph's Health Care London, London, Ontario, Canada.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Viana
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
mesh_terms: D000818:Animals; D001132:Arm / Q000502:physiology; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D009068:Movement; D010342:Patient Acceptance of Health Care; D026741:Physical Therapy Modalities; D012149:Restraint, Physical / Q000379:methods*; D020521:Stroke / Q000523:psychology; D000071939:Stroke Rehabilitation