title: Modified constraint-induced movement therapy for upper extremity recovery post stroke: what is the evidence?
abstract: BACKGROUND
  Constraint-induced movement therapy (CIMT) is an effective treatment for upper extremity (UE) recovery post stroke. Difficulties implementing a traditional CIMT approach have led to development of protocols featuring varying practice schedules, including a 10-week, 3 times per week intervention, termed modified CIMT (mCIMT). To date, systematic reviews of CIMT have grouped the various protocols, precluding the ability to ascertain the level of evidence (LOE) of specific CIMT protocols. Knowing the LOE for various protocols and their relative effectiveness may facilitate decision making regarding which protocol to implement.
  
  
  OBJECTIVE
  The aim of this study was to determine the LOE of mCIMT in promoting UE recovery post stroke.
  
  
  METHODS
  A comprehensive literature search and subsequent analysis identified studies of a range of designs that investigated the mCIMT protocol. Two independent reviewers assigned an LOE to each of the identified studies, which were then examined collectively to determine the overall LOE for mCIMT. Study results were reviewed to assess the effectiveness of mCIMT for improving UE recovery.
  
  
  RESULTS
  Of 473 studies identified, 15 utilized mCIMT. The lack of randomized controlled trials (RCT) resulted in assigning an intermediate LOE (C). Study results indicated that participants receiving mCIMT experienced clinically significant improvements in UE impairment and activity-level attributes.
  
  
  CONCLUSIONS
  The mCIMT protocol is an effective intervention for UE recovery post stroke. Future research including large RCTs could potentially increase the LOE for mCIMT. Additional investigation into the effectiveness of mCIMT in acute and subacute stroke populations is warranted given the limited number of studies performed to date.
authors.affiliation: Laboratory for Brain Recovery and Function, School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Alana
authors.initials: A
authors.lastname: Fleet
authors.affiliation: School of Health and Rehabilitation Sciences, The Ohio State University Wexner Medical Center, Columbus, Ohio B.R.A.I.N. (Better Rehabilitation and Assessment for Improved Neuro-recovery) Laboratory, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Page
authors.affiliation: Laboratory for Brain Recovery and Function, School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia Department of Medicine, Division of Physical Medicine and Rehabilitation, Capital Health, Halifax, Nova Scotia Department of Medicine, Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Marilyn
authors.initials: M
authors.lastname: MacKay-Lyons
authors.affiliation: Laboratory for Brain Recovery and Function, School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia Department of Medicine, Division of Physical Medicine and Rehabilitation, Capital Health, Halifax, Nova Scotia Department of Medicine, Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Nova Scotia School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario.
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Boe
mesh_terms: D003710:Demography; D019317:Evidence-Based Medicine; D006801:Humans; D009068:Movement; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012149:Restraint, Physical; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000502:physiology*
keywords: cerebrovascular disease; constraint-induced movement therapy; rehabilitation; systematic review; upper extremity