A META-ANALYSIS OF CONSTRAINT-INDUCED MOVEMENT THERAPY AFTER STROKE

Objective: 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. Data sources: PubMed, EMBASE, Cochrane and PEDro trial registers were searched for clinical trials published before November 2012. Study selection: Randomized or quasi-randomized controlled trials of constraint-induced movement therapy lasting 2-7 h/day for 8-28 days were included. Data extraction: 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. Data synthesis: Of 3,842 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). Conclusion: Constraint-induced movement therapy can improve arm motor function and improve arm motor activities and may have a lasting effect on arm motor activity.