Outcomes 12 months after a constraint induced movement therapy program were maintained for an additional year

Abstract

What is the retention of improvements 24 months after a 2-week constraint-induced movement therapy (CIMT) intervention in stroke survivors? Follow-up 24 months after a single blind, cross over, randomised controlled trial of CIMT. This paper reports follow-up data for the intervention group that received CIMT without delay only. Seven US academic clinical sites. 106 out of 222 participants with mild to moderate post-stroke impairment who had experienced the stroke in the previous 3 to 9 months. CIMT was delivered for two weeks. During the two weeks, participants wore a padded protective mitt that covered their less impaired wrist and hand up to 6 h per day, 5 days per week. The mitt was to be worn for 90% of waking hours. During that time participants did adaptive task practice or repetitive practice of specific tasks, such as grooming or eating, continuously for 15–20 minutes. Contracts with participants and caregivers were used to promote adherence to mitt use. Primary outcomes were function of the paretic upper limb, measured with the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL) measured at 12, 12.5, 16, 20, and 24 months. Health-related quality of life, measured with the Stroke Impact Scale (SIS), was a secondary outcome assessed at 12, 16, and 24 months. WMFT is a laboratory-based measure of upper limb motor function that consists of 15 timed movement tasks and two strength-based tasks. The MAL is a structured interview that assesses 30 activities of daily living on a 6-point scale when using the paretic arm. 34% of the participants who received CIMT immediately after allocation had dropped out at 24 months. From month 12 to month 24, the time taken to complete the WMFT did not decline significantly (mean difference 0.32 s longer, 95% CI –3.06 to 3.70). Over the same period, outcomes improved for weight lifted in the WMFT (1.39 kg, 95% CI 0.04 to 2.74) and for WMFT grip strength (4.39 kg, 95% CI 1.86 to 6.91). There were no significant differences in the amount of use in the MAL (0.17, 95% CI –0.04 to 0.38) and how well the limb was used in the MAL (0.14, 95% CI –0.06 to 0.34). Outcomes that had improved significantly 12 months after a 2-week CIMT program were maintained for an additional year.