ABSTRACT
Background: Constraint induced movement therapy (CIMT) is effective at improving upper limb outcomes after stroke. Aim: The aim of this study was to carry out a systematic review and meta-analysis of the effects of lower limb CIMT studies of any design in people with stroke. Materials/ Method: PubMED, PEDro, OTSeeker, CENTRAL, and Web of Science were searched from their earliest dates to February 2021. Lower limbs CIMT studies that measured outcomes at baseline and post-intervention were selected. Sample size, mean, and standard deviation on the outcomes of interest and the protocols of both the experimental and control groups were extracted. McMaster Critical Review Form was used to assess the methodological quality of the studies. Result: Sixteen studies with different designs were included in this review. The result showed that lower limb CIMT improves functional, physiological and person's reported outcomes including motor function, balance, mobility, gait speed, oxygen uptake, exertion before and after commencement of activities, knee extensor spasticity, weight bearing, lower limb kinematics and quality of life in people with stroke post intervention. However, there were only significant differences in quality of life in favor of CIMT post-intervention [mean difference (MD) = 16.20, 95% CI = 3.30-29.10, p = 0.01]; and at follow-up [mean difference (MD) = 14.10, 95% CI = 2.07-26.13, p = 0.02] between CIMT and the control group. Even for the quality of life, there was significant heterogeneity in the studies post intervention (I 2 = 84%, p = 0.01). Conclusion: Lower limb CIMT improves motor function, balance, functional mobility, gait speed, oxygen uptake, weigh bearing, lower limb kinematics, and quality of life. However, it is only superior to the control at improving quality of life after stroke based on the current literature.
ABSTRACT
Constraint-induced movement therapy (CIMT) is used for the rehabilitation of motor function after stroke. The aim of this review was to investigate its effect on persons-reported outcomes of health status (PROsHS) compared with conventional therapy. The study was a systematic review and meta-analysis registered in PROSPERO (CRD42019142279). Five databases PubMED, PEDro, OTSeeker, CENTRAL and Web of Science were searched. Randomized controlled trials were included if they assessed PROsHS. Mean scores of PROsHS, sample size and dose of CIMT and control groups interventions were extracted. The result was analyzed using qualitative and quantitative syntheses. Nine studies (n = 558) were included in the review. From the result, CIMT significantly improved PROsHS postintervention. However, postintervention, there was no statistically significant difference between groups for the upper limb [Mean difference (MD) = 6.67, 95% confidence interval (CI) = -2.09 to 15.44, P = 0.14] and the lower limb (MD = -1.86, 95% CI = -16.29 to 12.57, P = 0.80). Similarly, there was no statistically significant percentage of variation across studies, upper limb (I2 = 0%, P = 0.92) and lower limb (I2 = 0%, P = 0.86). For the lower limb at follow-up, there was no statistically significant difference between groups (MD = 0.97, 95% CI = -13.59 to 15.53, P = 0.90). When upper and lower limbs studies were pooled, there was no statistically significant difference between groups postintervention (MD = 0.22, 95% CI = -0.15 to 0.58, P = 0.24) and at follow-up (MD = 0.03, 95% CI = -0.43 to 0.49, P = 0.90). CIMT improves PROsHS after stroke. However, it is not superior to conventional therapy based on the current literature.
