Constraint‐induced movement therapy for upper extremities in stroke patients

Valeria Sirtori; Davide Corbetta; Lorenzo Moja; Roberto Gatti

doi:10.1002/14651858.CD004433.pub2

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Analysis 1.1

Comparison 1 Constraint versus control: primary outcome, Outcome 1 Disability post‐intervention.

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Analysis 2.1

Comparison 2 Constraint versus control: primary outcome, Outcome 1 Disability ‐ three to six‐month follow up.

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Analysis 3.1

Comparison 3 Constraint versus control: subgroup analysis on primary outcome, Outcome 1 Amount of task practice.

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Analysis 3.2

Comparison 3 Constraint versus control: subgroup analysis on primary outcome, Outcome 2 Anatomical region restraint.

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Analysis 3.3

Comparison 3 Constraint versus control: subgroup analysis on primary outcome, Outcome 3 Time since stroke.

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Analysis 4.1

Comparison 4 Constraint versus control: secondary outcomes, Outcome 1 Arm Motor Function.

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Analysis 4.2

Comparison 4 Constraint versus control: secondary outcomes, Outcome 2 Perceived Arm Motor Function (Amount of Use).

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Analysis 4.3

Comparison 4 Constraint versus control: secondary outcomes, Outcome 3 Perceived Arm Motor Function (Quality of Use).

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Analysis 4.4

Comparison 4 Constraint versus control: secondary outcomes, Outcome 4 Arm Motor Impairment.

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Analysis 4.5

Comparison 4 Constraint versus control: secondary outcomes, Outcome 5 Quality of life.

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Table 1. Criteria for subgroup analysis

Study ID	Dosage of practice	Anatomical restraint	Constraint effect	Time since stroke
	1 = 3 hour or less; 2 = more than 3 hours	1 = only hand; 2 = both arm and hand	1 = constraint; 2 = constraint plus shaping techniques	1 = 0 to 3 months; 2 = 3 to 9 months; 3 = more than 9 months; 4 = wide range (from 0.5 to 37 months)
Alberts 2004	2	1	2	2
Atteya 2004	1	2	2	2
Boake 2007	2	1	2	1
Dahl 2008	2	1	2	4
Dromerick 2000	1	1	2	1
Lin 2007	1	1	2	3
Myint 2008	2	2	2	1
Page 2001	1	2	2	2
Page 2002b	1	2	2	2
Page 2004	1	2	2	3
Page 2005a	1	1	2	1
Page 2008	1	2	2	3
Ploughman 2004	1	1	1	1
Taub 1993	2	2	2	3
Wittenberg 2003	2	2	2	3
Wolf 2006	2	1	2	2
Wu 2007a	1	1	2	4
Wu 2007b	1	1	2	4
Wu 2007c	1	1	2	4

Table 1. Criteria for subgroup analysis

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Table 2. Outcome measures used in the included studies

Study ID	Arm motor function	Perceived motor function	Dexterity	Arm motor impairment	Activities of daily living measures	Quality of life	Kinematics	Neurophysiologics	Strength
Alberts 2004	Wolf Motor Function Test			Fugl Meyer Assessment					Hand Dynamometert
Atteya 2004	Action Research Arm Test, Wolf Motor Function Test	Motor Activity Log		Fugl Meyer Assessment
Boake 2007		Motor Activity Log	Grooved Pegboard Test	Fugl Meyer Assessment				Transcranial magnetic stimulation
Dahl 2008	Wolf Motor Function Test	Motor Activity Log			Functional Independence Measure	Stroke Impact Scale
Dromerick 2000	Action Research Arm Test
Lin 2007		Motor Activity Log			Functional Independence Measure		Yes
Myint 2008	Action Research Arm Test	Motor Activity Log	Nine Holes Peg Test		Bartel Index
Page 2001	Action Research Arm Test, Wolf Motor Function Test	Motor Activity Log		Fugl Meyer Assessment
Page 2002b	Action Research Arm Test	Motor Activity Log		Fugl Meyer Assessment
Page 2004	Action Research Arm Test	Motor Activity Log		Fugl Meyer Assessment
Page 2005a	Action Research Arm Test	Motor Activity Log		Fugl Meyer Assessment
Page 2008	Action Research Arm Test	Motor Activity Log		Fugl Meyer Assessment
Ploughman 2004	Action Research Arm Test			Chedoke McMaster Impairment Inventory	Functional Independence Measure				Jamar
Taub 1993	Emory Motor Function Test	Motor Activity Log
Wittenberg 2003	Wolf Motor Function Test	Motor Activity Log						Transcranial magnetic stimulation, positron emission tomography
Wolf 2006	Wolf Motor Function Test	Motor Activity Log				Stroke Impact Scale
Wu 2007a		Motor Activity Log			Functional Independence Measure	Stroke Impact Scale	Yes
Wu 2007b		Motor Activity Log		Fugl Meyer Assessment			Yes
Wu 2007c		Motor Activity Log		Fugl Meyer Assessment	Functional Independence Measure	Stroke Impact Scale

Table 2. Outcome measures used in the included studies

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Comparison 1. Constraint versus control: primary outcome

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Disability post‐intervention Show forest plot	6	184	Std. Mean Difference (IV, Random, 95% CI)	0.36 [0.06, 0.65]

Comparison 1. Constraint versus control: primary outcome

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Comparison 2. Constraint versus control: primary outcome

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Disability ‐ three to six‐month follow up Show forest plot	2	73	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.53, 0.40]

Comparison 2. Constraint versus control: primary outcome

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Comparison 3. Constraint versus control: subgroup analysis on primary outcome

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Amount of task practice Show forest plot	6		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 ≤ 30 hours	4	111	Std. Mean Difference (IV, Fixed, 95% CI)	0.58 [0.20, 0.97]
1.2 > 30 hours	2	73	Std. Mean Difference (IV, Fixed, 95% CI)	0.02 [‐0.44, 0.49]
2 Anatomical region restraint Show forest plot	6		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.1 Arm plus hand	1	43	Std. Mean Difference (IV, Fixed, 95% CI)	0.02 [‐0.58, 0.61]
2.2 Only hand	5	141	Std. Mean Difference (IV, Fixed, 95% CI)	0.47 [0.13, 0.81]
3 Time since stroke Show forest plot	4		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 Zero to three months	2	66	Std. Mean Difference (IV, Fixed, 95% CI)	0.18 [‐0.31, 0.67]
3.2 Three to nine months	0	0	Std. Mean Difference (IV, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 More than nine months	2	62	Std. Mean Difference (IV, Fixed, 95% CI)	0.49 [‐0.02, 1.00]

Comparison 3. Constraint versus control: subgroup analysis on primary outcome

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Comparison 4. Constraint versus control: secondary outcomes

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Arm Motor Function Show forest plot	11	373	Std. Mean Difference (IV, Random, 95% CI)	0.72 [0.32, 1.12]

1.1 Constraint therapy versus usual care	9	348	Std. Mean Difference (IV, Random, 95% CI)	0.64 [0.27, 1.01]
1.2 Constraint therapy versus no treatment	2	25	Std. Mean Difference (IV, Random, 95% CI)	2.05 [‐1.11, 5.21]
2 Perceived Arm Motor Function (Amount of Use) Show forest plot	10	457	Mean Difference (IV, Fixed, 95% CI)	1.16 [1.05, 1.27]

2.1 CIMT versus usual care	9	441	Mean Difference (IV, Fixed, 95% CI)	1.16 [1.04, 1.27]
2.2 CIMT versus no treatment	1	16	Mean Difference (IV, Fixed, 95% CI)	1.17 [0.71, 1.63]
3 Perceived Arm Motor Function (Quality of Use) Show forest plot	10	450	Mean Difference (IV, Fixed, 95% CI)	0.87 [0.75, 0.98]

3.1 CIMT versus usual care	9	441	Mean Difference (IV, Fixed, 95% CI)	0.83 [0.71, 0.95]
3.2 CIMT versus no treatment	1	9	Mean Difference (IV, Fixed, 95% CI)	1.6 [1.04, 2.16]
4 Arm Motor Impairment Show forest plot	8	161	Std. Mean Difference (IV, Random, 95% CI)	0.65 [0.15, 1.15]

4.1 Constraint therapy versus usual care	8	161	Std. Mean Difference (IV, Random, 95% CI)	0.65 [0.15, 1.15]
4.2 Constraint therapy versus no treatment	0	0	Std. Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
5 Quality of life Show forest plot	2	56	Mean Difference (IV, Fixed, 95% CI)	6.68 [‐6.51, 19.87]

5.1 Constraint therapy versus usual care	2	56	Mean Difference (IV, Fixed, 95% CI)	6.68 [‐6.51, 19.87]

Comparison 4. Constraint versus control: secondary outcomes

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