Reduced-intensity modified constraint-induced movement therapy versus conventional therapy for upper extremity rehabilitation after stroke: a multicenter trial.
BACKGROUND
Constraint-induced movement therapy (CIMT) is a rehabilitation approach for arm paresis consisting of an intensive schedule of treatment (6 h/d). The high demand of resources for CIMT is a critical issue for its implementation in the Italian health system.


OBJECTIVE
To compare the effects of a reduced-intensity modified CIMT (mCIMT) program that included splinting the unaffected arm for 12 hours daily with the effects of a conventional rehabilitation program for arm paresis in patients with stroke.


METHODS
Sixty-six participants with hemiparesis (3-24 months poststroke) who could extend the wrist and several fingers at least 10° were randomly assigned to mCIMT or conventional rehabilitation. Each group underwent 10 (2 h/d) treatment sessions (5 d/wk for 2 weeks). Patients were assessed with the Wolf Motor Function Test (WMFT-FA and WMFT-T), the Motor Activity Log (MAL-AOU and MAL-QOM), and the Ashworth Scale before and after treatment and 3 months later.


RESULTS
Between-groups analysis showed that the mCIMT group overall had greater improvement than the control group in terms of the WMFT-FA (P = .010), MAL-AOU (P < .001), and MAL-QOM (P < .001). Differences between groups were significant both after treatment (P < .01) and at the 3-month follow-up (P < .01), although 40% of participants did not complete the 3-month assessment. Furthermore, the mCIMT group showed a greater decrease of Ashworth Scale score than the control group at 3 months (P = .021).


CONCLUSIONS
Two hours of CIMT may be more effective than conventional rehabilitation in improving motor function and use of the paretic arm in patients with chronic stroke.
University of Verona, Verona, Italy. nicola.smania@univr.it
Nicola
N
Smania
Marialuisa
M
Gandolfi
Stefano
S
Paolucci
Marco
M
Iosa
Patrizia
P
Ianes
Serena
S
Recchia
Chiara
C
Giovanzana
Franco
F
Molteni
Renato
R
Avesani
Pietro
P
Di Paolo
Massimo
M
Zaccala
Michela
M
Agostini
Cristina
C
Tassorelli
Antonio
A
Fiaschi
Daniela
D
Primon
Maria Grazia
MG
Ceravolo
Simona
S
Farina
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009048:Motor Skills / Q000502:physiology; D009068:Movement / Q000502:physiology*; D009129:Muscle Tonus / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology; D026741:Physical Therapy Modalities; D018401:Sample Size; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000502:physiology*