CIMT
The power is in your hands
Systematic review and meta-analysis of constraint-induced movement therapy in the hemiparetic upper extremity more than six months post stroke
McIntyre, A., Viana, R., Janzen, S., Mehta, S., Pereira, S., & Teasell, R. (2012)
Objective of the Systematic Review
To determine, from the available evidence, the effectiveness of constraint-induced movement therapy (CIMT) on treating individuals with hemiparetic upper extremity (UE) who were more than six months post-stroke.
Study Design
Search strategy
Literature search of multiple databases including MEDLINE, CINAHL, and EMBASE for articles published in English language and up to July 2012.
Selection criteria
Studies included for review if (1) ≥50% of sample had a stroke, (2) research design used was randomized controlled trials (RCTs), (3) sample was more than six months post stroke, (4) treatment group received CIMT, (5) control group received traditional rehabilitation, and (6) functional outcome assessed pre- and post-treatment.
Participants:
- Total subjects were 572 (190 females and 358 males)
- Age 30-87 years
- Mean time since stroke was 22.7 mths.
- Participants' MMSE score was >20.
- Individuals did not have balance issues.
Intervention
Control
(Traditional rehabilitation)
Participants received traditional rehabilitation of affected and/or unaffected arm using neurodevelopmental treatments, standard rehabilitation, bilateral arm training, bimanual activities, or combination of these.
Experimental
(Constraint-induced therapy)
Duration of treatment occurred for 10 days to a maximum of 10 weeks. Treatment consisted of repetitive, task-specific, and graded tasks. Functional activities were incorporated into practice tasks to promote generalizability.
Study appraisal
Articles were selected using Physiotherapy Evidence Database (PEDro).
Data synthesis
- 16 papers from published studies were used in this systematic review.
- Fixed and random effects model was used for analysis of degree of heterogeneity between studies.
Image 24. Newspapers
Image 25. Web of People
Image 26. Bar Graph
Outcome Measures
- Amount of Use (AOU)
- Quality of Movement (QOM)
- Wolf Motor Function Test (WMFT)
- Fugl-Meyer Assessment (FMA),
- Action Research Arm Test (ARAT),
- subscale of Motor Activity Log (MAL)
- Functional Independence Measure (FIM)
Main Findings
• ARAT and FMA showed significant improvement for those receiving CIMT compared to control groups for functional performance. No significant difference was found by WMFT.
• AOU and QOM scores showed that CIMT participants had greater functional status in real world applications than control participants.
• FIM found no significant change in burden of care between both groups.
Authors’ Conclusions
CIMT was effective at improving UE function during daily activities compared to standard therapy. As a result, practitioners now have more treatment options for use with individuals who experience functional impairments related to stroke. Researchers of rehabilitation should be encouraged to study other therapeutic interventions in chronic post-stroke populations