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. 2012 Fall;64(4):397-413.
doi: 10.3138/ptc.2011-24.

Constraint-Induced Movement Therapy Compared to Dose-Matched Interventions for Upper-Limb Dysfunction in Adult Survivors of Stroke: A Systematic Review with Meta-analysis

Ted Stevenson  1 , Leyda Thalman, Heather Christie, William Poluha
Affiliations

Constraint-Induced Movement Therapy Compared to Dose-Matched Interventions for Upper-Limb Dysfunction in Adult Survivors of Stroke: A Systematic Review with Meta-analysis

Ted Stevenson et al. Physiother Can. 2012 Fall.

Abstract
in English, French

Purpose: To summarize the existing literature examining constraint-induced movement therapy (CIMT), relative to dose-matched control interventions, for upper-limb (UL) dysfunction in adult survivors of stroke.

Methods: CINAHL, Cochrane Library, Embase, NARIC/CIRRIE-Rehabdata, PEDro, PubMed, Scopus, and Web of Science were searched from their inception to February 2011. Trial quality was described using the PEDro scale. The findings were summarized with meta-analysis.

Results: For the 22 trials identified, the mean (SD) PEDro score was 6.4 (1.2). Meta-analysis showed CIMT to be superior to dose-matched interventions based on indicators of UL motor capacity (15 trials, n=432; standardized mean difference [SMD]=0.47, 95% CI, 0.27-0.66) and UL ability (14 trials, n=352; SMD=0.80, 95% CI, 0.57-1.02); Functional Independence Measure scores (6 trials, n=182; mean difference [MD]=5.05, 95% CI, 2.23-7.87); and Motor Activity Log scores (Amount of Use: 12 trials, n=318; MD=1.05, 95% CI, 0.85-1.24; Quality of Movement: 11 trials, n=330; MD=0.89, 95% CI, 0.69-1.08).

Conclusions: Compared to control interventions of equal duration and dose, CIMT produced greater improvements in a variety of indicators of UL function in adult survivors of a stroke with residual movement of their upper limb.

Objectif : Faire la synthèse de la littérature existante traitant de la thérapie par contrainte induite (TCI) par rapport aux interventions de contrôle avec dosage équivalent dans les cas de dysfonctions des membres supérieurs chez les adultes ayant survécu à un accident vasculaire cérébral. Méthode : Une recherche a été effectuée dans CINAHL, dans la bibliothèque de Cochrane, dans Embase, NARIC/CIRRIE—Rehabdata, PEDro, PubMed, Scopus, et Web of Science depuis leur mise en ligne jusqu'en février 2011. La qualité des recherches a été évaluée à l'aide de l'échelle PEDro. Les conclusions ont été résumées à l'aide d'une méta-analyse. Résultats : Au total, 22 essais ont été répertoriés; la moyenne de leur cote à l'échelle PEDro était de 6,4 (SD1 de 0,2). La méta-analyse a révélé que la TCI est supérieure aux interventions de contrôle avec dosage équivalent pour les indicateurs de capacité motrice des membres supérieurs (15 essais, n=432; MDS=0,47; 95%IC, 0,27–0,66); capacité des membres supérieurs (14 essais, n=352; MDS=0,80; 95%IC, 0,57–1,02); mesure de l'autonomie fonctionnelle [Functional Independence Measure] (6 essais, n=182; DM=5,05; 95%IC, 2,23–7,87); et score du journal de l'activité motrice [Motor Activity Log] (quantité d'utilisation : 12 essais, n=318; DM=1,05; 95%IC, 0,85–1,24; qualité du mouvement : 11 essais, n=330; DM=0,89; 95%IC 0,69–1,08). Conclusions : Si on la compare aux interventions de contrôle de durée et avec dosage équivalents, la TCI suscite de plus grandes améliorations dans une variété d'indicateurs de la fonction des membres supérieurs chez les adultes ayant survécu à un AVC avec mouvement résiduel de leurs membres supérieurs.

Keywords: constraint-induced movement therapy; rehabilitation; stroke; upper extremity.

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Figures

Figure 1
Figure 1
Flow diagram showing accounting of studies through the search process.
Figure 2
Figure 2
Forest plot of findings from studies comparing CIMT to dose-matched control intervention for upper-limb motor capacity outcomes.
Figure 3
Figure 3
Forest plot of findings from studies comparing the effect of CIMT and dose-matched control intervention on indicators of upper-limb ability.
Figure 4
Figure 4
Forest plot summarizing findings from studies comparing CIMT to dose-matched control intervention for Functional Independence Measure scores immediately after completion of the intervention.
Figure 5
Figure 5
Forest plot of findings from trials comparing the effects of CIMT and dose-matched control intervention on performance on the Amount of Use sub-scale of the Motor Activity Log.
Figure 6
Figure 6
Forest plot of findings from trials comparing the effects of CIMT and dose-matched control intervention on performance on the Quality of Movement sub-scale of the Motor Activity Log.
See this image and copyright information in PMC

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