A meta-analysis of constraint-induced movement therapy after stroke.

Abstract

To evaluate the effect of constraint-induced movement therapy in adult stroke patients and to examine the impact of time since stroke and various treatment modalities. PubMed, EMBASE, Cochrane and PEDro trial registers were searched for clinical trials published before November 2012. Randomized or quasi-randomized controlled trials of constraint-induced movement therapy lasting 2-7 h/day for 8-28 days were included. Measurements were classified into the following categories: arm motor function, arm motor activity, activities of daily living, and participation. A pooled standardized mean difference (SMD) was calculated for each category. Moderators were: trial quality, behavioural techniques, amount of training, time since stroke, shaping, and the nature of the control group. Of 3842 records initially screened 23 trials were included. A small post-treatment effect was found on arm motor function (SMD 0.28, 95% confidence interval (CI) 0.11-0.44). Meanwhile, a moderate effect on arm motor activity was found post-treatment (SMD 0.51, 95% CI 0.30-0.73) and at 3-6 months follow-up (SMD 0.41, 95% CI 0.08-0.74). Constraint-induced movement therapy can improve arm motor function and improve arm motor activities and may have a lasting effect on arm motor activity.