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Constraint-induced movement therapy as a rehabilitation intervention for upper extremity in stroke patients

systematic review and meta-analysis

Etoom, Mohammad; Hawamdeh, Mohannad; Hawamdeh, Ziad; Alwardat, Mohammad; Giordani, Laura; Bacciu, Serenella; Scarpini, Claudia; Foti, Calogero

International Journal of Rehabilitation Research: September 2016 - Volume 39 - Issue 3 - p 197–210
doi: 10.1097/MRR.0000000000000169
Review articles

Constraint-induced movement therapy (CIMT) is a neurorehabilitation technique designed to improve upper extremity motor functions after stroke. This review aimed to investigate evidence of the effect of CIMT on upper extremity in stroke patients and to identify optimal methods to apply CIMT. Four databases (MEDLINE, EMBASE, CINHAL, and PEDro) and reference lists of relevant articles and reviews were searched. Randomized clinical trials that studied the effect of CIMT on upper extremity outcomes in stroke patients compared with other rehabilitative techniques, usual care, or no intervention were included. Methodological quality was assessed using the PEDro score. The following data were extracted for each trial: patients’ characteristics, sample size, eligibility criteria, protocols of CIMT and control groups, outcome measurements, and the PEDro score. A total of 38 trials were identified according to the inclusion criteria. The trials included were heterogeneous in CIMT protocols, time since stroke, and duration and frequency of treatment. The pooled meta-analysis of 36 trials found a heterogeneous significant effect of CIMT on upper extremity. There was no significant effect of CIMT at different durations of follow-up. The majority of included articles did not fulfill powered sample size and quality criteria. The effect of CIMT changed in terms of sample size and quality features of the articles included. These meta-analysis findings indicate that evidence for the superiority of CIMT in comparison with other rehabilitative interventions is weak. Information on the optimal dose of CIMT and optimal time to start CIMT is still limited.

aAdvance Sciences and Technologies in Medical Rehabilitation and Sport

bPhysical Activity and Health Promotion and

cPhysical and Rehabilitation Medicine, Tor Vergata University, Rome, Italy

dPhysical and Occupational Therapy Department, The Hashmite University, Zarqa

ePhysical Medicine and Rehabilitation, Faculty of Medicine, The University of Jordan, Amman, Jordan

Correspondence to Mohammad Etoom, PhD, ‘Advance Sciences and Technologies in Medical Rehabilitation and Sport’, Tor Vergata University, Rome-Italy, via montpellier, 1 Rome, Italy Tel: +39 389 487 1119; fax: +39 672 596 652; e-mail:

Received February 15, 2016

Accepted March 21, 2016

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