Effect of constraint-induced movement therapy on lower extremity motor dysfunction in post-stroke patients: A systematic review and meta-analysis

Abstract

ObjectiveConstraint-induced movement therapy (CIMT) is a common treatment for upper extremity motor dysfunction after a stroke. However, whether it can effectively improve lower extremity motor function in stroke patients remains controversial. This systematic review comprehensively studies the current evidence and evaluates the effectiveness of CIMT in the treatment of post-stroke lower extremity motor dysfunction.MethodsWe comprehensively searched randomized controlled trials related to this study in eight electronic databases (PubMed, Embase, The Cochrane Library, Web of Science, CBM, CNKI, WAN FANG, and VIP). We evaluated CIMT effectiveness against post-stroke lower extremity motor dysfunction based on the mean difference and corresponding 95% confidence interval (95% CI). We assessed methodological quality based on the Cochrane Bias Risk Assessment Tool. After extracting the general information, mean, and standard deviation of the included studies, we conducted a meta-analysis using RevMan 5.3 and Stata 16.0. The primary indicator was the Fugl-Meyer Assessment scale on lower limbs (FMA-L). The secondary indicators were the Berg balance scale (BBS), 10-meter walk test (10MWT), gait speed (GS), 6-min walk test (6MWT), functional ambulation category scale (FAC), timed up and go test (TUGT), Brunnstrom stage of lower limb function, weight-bearing, modified Barthel index (MBI), functional independence measure (FIM), stroke-specific quality of life questionnaire (SSQOL), World Health Organization quality of life assessment (WHOQOL), and National Institute of Health stroke scale (NIHSS).ResultsWe initially identified 343 relevant studies. Among them, 34 (totaling 2,008 patients) met the inclusion criteria. We found that patients treated with CIMT had significantly better primary indicator (FMA-L) scores than those not treated with CIMT. The mean differences were 3.46 (95% CI 2.74–4.17, P < 0.01, I2 = 40%) between CIMT-treated and conventional physiotherapy-treated patients, 3.83 (95% CI 2.89–4.77, P < 0.01, I2 = 54%) between patients treated with CIMT plus conventional physiotherapy and patients treated only with conventional physiotherapy, and 3.50 (95% CI 1.08–5.92, P < 0.01) between patients treated with CIMT plus western medicine therapy and those treated only with western medicine therapy. The secondary indicators followed the same trend. The subgroup analysis showed that lower extremity CIMT with device seemed to yield a higher mean difference in FMA-L scores than lower extremity CIMT without device (4.52, 95% CI = 3.65–5.38, P < 0.01 and 3.37, 95% CI = 2.95–3.79, P < 0.01, respectively).ConclusionCIMT effectively improves lower extremity motor dysfunction in post-stroke patients; however, the eligible studies were highly heterogeneous.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=277466.

Comparative Efficacy of Constrained Induced Movement Therapy and Motor-Relearning Program in Post Stroke Upper Extremity Function

“…The efficacy of various therapies for post-stroke upper extremity function has been the subject of numerous studies. Significant improvements with CIMT in both lower and upper extremity functions have been reported (12,13,14,15), while other studies have highlighted the effectiveness of robot-assisted training and proprioceptive-based training over conventional therapies (16). Additionally, resistance training has been shown to improve motor recovery, function, and quality of life (17).…”

Modified constraint-induced movement therapy for lower limb intervention on patients with stroke: A Scoping Review

“…It overcomes learned nonuse by restraining the non-paretic side and repetitively exercising the paralyzed extremity [6]. CIMT is developed for the upper extremity (UE), while modi ed CIMT (mCIMT) can be employed to enhance the utilization and rehabilitation of the paralyzed lower extremity (LE) [7][8][9]. mCIMT offers a more exible protocol, including partial constraint, intensive exercise, shaping training, and transfer package [9,10].…”

“…CIMT is developed for the upper extremity (UE), while modi ed CIMT (mCIMT) can be employed to enhance the utilization and rehabilitation of the paralyzed lower extremity (LE) [7][8][9]. mCIMT offers a more exible protocol, including partial constraint, intensive exercise, shaping training, and transfer package [9,10]. The application of mCIMT is aimed at improving LE movement disorders.…”

Effects of Kinesio Taping and Modified Constraint-Induced Movement Therapy on Upper Extremity Function, Quality of Life, and Spasticity in Individuals Recovering from Stroke

“…The task-specific practice of mCIMT could further consolidate gains in proprioception and movement facilitated by KT. Moreover, mCIMT's emphasis on forced use might intensify KT's effects on sensory and muscle activation, potentially yielding greater functional improvements (15,16). The integration of KT and mCIMT has not been fully explored, and this study aims to comprehensively analyze their combined impact on spasticity, quality of life, and upper limb functionality in individuals post-stroke.…”