Article

OBJECTIVE: To compare the effectiveness of modified constraint-induced movement
therapy (CIMT) with traditional rehabilitation (TR) therapy in patients with
upper-extremity dysfunction after stroke. DATE SOURCES: Computerized database
searches and hand-searches, as 2 main search strategies, were used to collect
studies. A comprehensive search of PubMed, EMBASE, the Cochrane Library, the
Chinese academic journals full-text database, the Chinese biomedical literature
database, the Chinese scientific journals database, and Chinese medical
association journals was conducted. Relevant journals and article reference lists
were hand-searched. Meanwhile, we searched unpublished trials by using the System
for Information on Gray Literature database. STUDY SELECTION: Randomized
controlled trials (RCTs) only about modified CIMT versus TR for treatment of
patients with upper-extremity dysfunction after stroke were identified in this
systematic review. Participants included adults age over 18 years with a clinical
diagnosis of stroke and met the inclusion criteria of modified CIMT. DATE EXTRACTION: Two reviewers extracted relevant information from included studies
according to a date extraction form. The methodologic quality of the included
studies was assessed using a quality-scoring instrument, which was a 5-point
scale that included a description of randomization, double-blind structure, and
withdrawals/dropouts. DATA SYNTHESIS: Thirteen RCTs involving 278 patients
(modified CIMT/TR=143/135) were included. Meta-analysis showed that patients
receiving modified CIMT showed higher scores for the Fugl Meyer Assessment (mean
difference [MD]=7.8; 95% confidence interval [CI], 4.21-11.38), the Action
Research Arm Test (MD=14.15; 95% CI, 10.71-17.59), the FIM (MD=7.00; 95% CI,
.75-13.26), and the Motor Activity Log: Amount of Use (MD=.78; 95% CI, .37-1.19)
and Quality of Use (MD=.84; 95% CI, .42-1.25) than patients in the TR group. In
kinematic variables, patients receiving modified CIMT had a shorter reaction time
and a higher percentage of movement time where peak velocity occurred than
patients receiving TR (P<.05), while meta-analysis showed that there was no
significant difference in normalized movement time (P=.99), normalized total
displacement (P=.44), and normalized movement unit (P=.68). CONCLUSIONS: This
systematic review provided fairly strong evidence that modified CIMT could reduce
the level of disability, improve the ability to use the paretic upper extremity,
and enhance spontaneity during movement time, but evidence is still limited about
the effectiveness of modified CIMT in kinematic analysis.
CI - Copyright (c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS