Occupation-based intervention versus rote exercise in modified constraint-induced movement therapy for patients with median and ulnar nerve injuries: a randomized controlled trial.
OBJECTIVE
To investigate effect of practice type during modified constraint-induced movement therapy on hand function in patients with chronic median and ulnar nerve injuries.


METHODS
A prospective, single-blinded, randomized controlled clinical trial.


METHODS
Participants' private home.


METHODS
A convenience sample of 36 outpatient participants allocated randomly to three equal groups.


METHODS
Intervention groups underwent 3-hour intensive training of affected hand each day, 3-day a week, 4-week in association with immobilisation of healthy hand: occupation-based group practiced meaningful occupations while rote exercise-based group performed rote exercises during constraint-induced movement therapy. Control group performed different activities with affected hand for 1.5-hour each day during 4-week without restriction of healthy hand.


METHODS
A blinded assessor tested Canadian occupational performance measure, box and block, Static two-point discrimination, disabilities of arm, shoulder, hand questionnaire, and self-assessment manikin in a random order across sessions 3-time as baseline (pre-test), after 4-week intervention (post-test), and 1-month after intervention period (follow up).


RESULTS
Scores significantly changed in intervention groups compared to control. Despite significantly more improvement in occupation-based than rote exercise-based group in subjective measures at post-test and follow up (Canadian occupational performance measure: mean change 4.7 vs. 2.1 for performance, P< 0.001 and mean change 5.3 vs. 2.6 for satisfaction, P< 0.001), it was significant just at follow up for box and block and static two-point discrimination.


CONCLUSIONS
Practice content of constraint-induced movement therapy is a critical part of its effectiveness on improving outcomes following peripheral nerve repair in favour of occupation-based intervention in present study.
1 Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.|2 Department of Occupational Therapy, School of Rehabilitation Sciences, Esfahan University of Medical Sciences, Esfahan, Iran.
Hamid Reza
HR
Rostami
1 Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
Malahat
M
Akbarfahimi
1 Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
Afsoon
A
Hassani Mehraban
3 Department of Hand Microsurgery and Plastic Surgery, Laleh Hospital, Tehran, Iran.
Ali Reza
AR
Akbarinia
4 Cognitive Research Centre, Shahid Beheshti University, Tehran, Iran.
Susan
S
Samani
D000328:Adult; D000704:Analysis of Variance; D001134:Arm Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007492:Iran; D008297:Male; D020423:Median Neuropathy / Q000534:rehabilitation*; D008875:Middle Aged; D015915:Motion Therapy, Continuous Passive / Q000379:methods*; D009790:Occupations; D018579:Patient Selection; D059348:Peripheral Nerve Injuries / Q000175:diagnosis / Q000534:rehabilitation; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D016037:Single-Blind Method; D016896:Treatment Outcome; D020424:Ulnar Neuropathies / Q000175:diagnosis / Q000534:rehabilitation*
Constraint-induced movement therapy; median nerve; occupation-based intervention; rote exercise; ulnar nerve