Barriers to the Implementation of Constraint-Induced Movement Therapy Into Practice

Abstract

Background and Purpose: Constraint-induced movement therapy (CIMT) has been studied for many years in the treatment of the hemiplegic upper extremity (UE). However, there has been limited adoption of the protocol in daily practice. Methods: In this article, we review the CIMT literature specifically for meta-analysis, randomized controlled trials (RCTs), recent case reports, case series, and pilot studies of CIMT in the adult poststroke population to identify barriers to implementation. Results: The following barriers have been identified: (a) limited generalizability, (b) resource intensity, (c) therapist factors, (d) patient factors, and (e) uncertainty regarding the emerging debate that the gains seen may be a result of intense, task-specific therapy focused on the use of the more affected UE and not specific to the protocol. Conclusions: CIMT has positive outcomes in the treatment of a select group of stroke survivors. Many national guidelines of stroke rehabilitation recommend that CIMT be used when appropriate, however adoption into practice has been limited. The issue of generalizability is being addressed by expanding protocol application to other populations. Resource intensity, with respect to cost and therapist time, is a major concern and has lead to the development of novel modes of service deliveryThe benefit seen with CIMT may actually be the result of exposure to intense, task-specific therapy with a focus on the use of the more affected UE, but more research into this area is needed.