Systematic Review and Meta-Analysis of Constraint-Induced Movement Therapy in the Hemiparetic Upper Extremity More Than Six Months Post Stroke

Objective: To conduct a systematic review and meta-analysis of the available evidence on the effectiveness of constraint-induced movement therapy (CIMT) in the hemiparetic upper extremity (UE) among individuals who were more than 6 months post stroke. Methods: A literature search of multiple databases (PubMed, CINAHL, and EMBASE) was conducted to identify articles published in the English language up to and including July 2012. Studies were included for review if (1) >= 50% of the sample had sustained a stroke, (2) the research design was a randomized controlled trial (RCT), (3) the mean time since stroke was >= 6 months for both the treated and control groups, (4) the treatment group received CIMT, (5) the control group received a form of traditional rehabilitation, and (6) functional improvement was assessed both pre and posttreatment. Methodological quality was assessed using the PEDro tool with a score out of 10. Results: Sixteen RCTs (PEDro scores 4-8) met inclusion criteria and included a pooled sample size of 572 individuals with a mean age of 58.2 years (range, 30-87). The meta-analysis revealed a significant treatment effect on the amount of use and quality of movements subscales of the Motor Activity Log (P < .001, for both), Fugl-Meyer Assessment (P = .014), and Action Research Arm Test (P = .001); however, there was no significant treatment effect demonstrated by the Wolf Motor Function Test (P = .120) or FIM (P = .070). Conclusions: CIMT to improve UE function is an appropriate and beneficial therapy for individuals who have sustained a stroke more than 6 months previously.