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Constraint-induced movement therapy for the upper paretic limb in acute or sub-acute stroke: a systematic review

Authors

  • Rinske Nijland,

    1. Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Centre, Amsterdam, The Netherlands
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  • Gert Kwakkel,

    1. Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Centre, Amsterdam, The Netherlands
    2. Department of Rehabilitation Medicine, Rudolf Magnus Institute of Neuroscience, University Medical Centre, Utrecht, The Netherlands
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  • Japie Bakers,

    1. Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Centre, Amsterdam, The Netherlands
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  • Erwin van Wegen

    Corresponding author
    1. Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Centre, Amsterdam, The Netherlands
      Erwin E.H. van Wegen*, Department of Rehabilitation Medicine, VU University, Medical Centre, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
      E-mail: e.vanwegen@vumc.nl
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  • Conflict of interest: None declared.

Erwin E.H. van Wegen*, Department of Rehabilitation Medicine, VU University, Medical Centre, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
E-mail: e.vanwegen@vumc.nl

Abstract

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.

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