Modified constraint-induced movement therapy for upper extremity recovery post stroke: what is the evidence?

BACKGROUND Constraint-induced movement therapy (CIMT) is an effective treatment for upper extremity (UE) recovery post stroke. Difficulties implementing a traditional CIMT approach have led to development of protocols featuring varying practice schedules, including a 10-week, 3 times per week intervention, termed modified CIMT (mCIMT). To date, systematic reviews of CIMT have grouped the various protocols, precluding the ability to ascertain the level of evidence (LOE) of specific CIMT protocols. Knowing the LOE for various protocols and their relative effectiveness may facilitate decision making regarding which protocol to implement. OBJECTIVE The aim of this study was to determine the LOE of mCIMT in promoting UE recovery post stroke. METHODS A comprehensive literature search and subsequent analysis identified studies of a range of designs that investigated the mCIMT protocol. Two independent reviewers assigned an LOE to each of the identified studies, which were then examined collectively to determine the overall LOE for mCIMT. Study results were reviewed to assess the effectiveness of mCIMT for improving UE recovery. RESULTS Of 473 studies identified, 15 utilized mCIMT. The lack of randomized controlled trials (RCT) resulted in assigning an intermediate LOE (C). Study results indicated that participants receiving mCIMT experienced clinically significant improvements in UE impairment and activity-level attributes. CONCLUSION The mCIMT protocol is an effective intervention for UE recovery post stroke. Future research including large RCTs could potentially increase the LOE for mCIMT. Additional investigation into the effectiveness of mCIMT in acute and subacute stroke populations is warranted given the limited number of studies performed to date.