Constraint-Induced Movement Therapy Compared to Dose-Matched Interventions for Upper-Limb Dysfunction in Adult Survivors of Stroke: A Systematic Review with Meta-analysis

Purpose: To summarize the existing literature examining constraint-induced movement therapy (CIMT), relative to dose-matched control interventions, for upper-limb (UL) dysfunction in adult survivors of stroke. Methods: CINAHL, Cochrane Library, Embase, NARIC/CIRRIE-Rehabdata, PEDro, PubMed, Scopus, and Web of Science were searched from their inception to February 2011. Trial quality was described using the PEDro scale. The findings were summarized with meta-analysis. Results: For the 22 trials identified, the mean (SD) PEDro score was 6.4 (1.2). Meta-analysis showed CIMT to be superior to dose-matched interventions based on indicators of UL motor capacity (15 trials, n = 432; standardized mean difference [SMD] = 0.47, 95% CI, 0.27-0.66) and UL ability (14 trials, n = 352; SMD = 0.80, 95% CI, 0.57-1.02); Functional Independence Measure scores (6 trials, n = 182; mean difference [MD] = 5.05, 95% CI, 2.23-7.87); and Motor Activity Log scores (Amount of Use: 12 trials, n = 318; MD = 1.05, 95% CI, 0.85-1.24; Quality of Movement: 11 trials, n = 330; MD = 0.89, 95% CI, 0.69-1.08). Conclusions: Compared to control interventions of equal duration and dose, CIMT produced greater improvements in a variety of indicators of UL function in adult survivors of a stroke with residual movement of their upper limb.