Conflict of interest: None declared.
Constraint-induced movement therapy for the upper paretic limb in acute or sub-acute stroke: a systematic review
Article first published online: 23 SEP 2011
© 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization
International Journal of Stroke
Volume 6, Issue 5, pages 425–433, October 2011
How to Cite
Nijland, R., Kwakkel, G., Bakers, J. and van Wegen, E. (2011), Constraint-induced movement therapy for the upper paretic limb in acute or sub-acute stroke: a systematic review. International Journal of Stroke, 6: 425–433. doi: 10.1111/j.1747-4949.2011.00646.x
- Issue published online: 23 SEP 2011
- Article first published online: 23 SEP 2011
- constraint-induced movement therapy;
- neuronal plasticity;
- upper extremity
Abstract Constraint-induced movement therapy is a commonly used intervention to improve upper limb function after stroke. However, the effectiveness of constraint-induced movement therapy and its optimal dosage during acute or sub-acute stroke is still under debate. To examine the literature on the effects of constraint-induced movement therapy in acute or sub-acute stroke. A literature search was performed to identify randomized, controlled trials; studies with the same outcome measure were pooled by calculating the mean difference. Separate quantitative analyses for high-intensity and low-intensity constraint-induced movement therapy were applied when possible. Five randomized, controlled trials were included, comprising 106 participants. The meta-analysis demonstrated significant mean differences in favor of constraint-induced movement therapy for the Fugl–Meyer arm, the Action Research Arm Test, the Motor Activity Log, Quality of Movement and the Grooved Pegboard Test. Nonsignificant mean difference in favor of constraint-induced movement therapy were found for the Motor Activity Log, Amount of Use. Separate analyses for high-intensity and low-intensity constraint-induced movement therapy resulted in significant favorable mean differences for low-intensity constraint-induced movement therapy for all outcome measures, in contrast to high-intensity constraint-induced movement therapy. This meta-analysis demonstrates a trend toward positive effects of high-intensity and low-intensity constraint-induced movement therapy in acute or sub-acute stroke, but also suggests that low-intensity constraint-induced movement therapy may be more beneficial during this period than high-intensity constraint-induced movement therapy. However, these results were based on a small number of studies. Therefore, more trials are needed applying different doses of therapy early after stroke and a better understanding is needed about the different time windows in which underlying mechanisms of recovery operate.