Effectiveness of Constraint-Induced Movement Therapy (CIMT) on Balance and Functional Mobility in the Stroke Population: A Systematic Review and Meta-Analysis

Tedla, Jaya Shanker; Gular, Kumar; Reddy, Ravi Shankar; Ferreira, Arthur de Sá; Rodrigues, Elisa da Conceição; Kakaraparthi, Venkata Nagaraj; Gyer, Giles; Sangadala, Devika Rani; Qasheesh, Mohammed; Kovela, Rakesh Krishna; Nambi, Gopal

doi:10.3390/healthcare10030495

Cited by 20 publications

(21 citation statements)

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“…The limitations in the usage of the hand may further affect trunk stability [ 54 , 55 ]. The positive associations between the trunk and upper limb impairment observed in the present study suggested evaluating and minimizing the upper limb impairments and encouraging the utilization of the upper limb, which in turn can reduce the upper limb impairments and improve the trunk control, functional balance, and gait functions in late subacute stage [ 56 , 57 ].…”

Section: Discussionmentioning

confidence: 98%

The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis

Gular

Sivasubramanian

Reddy

et al. 2022

IJERPH

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Background: The trunk acts as proximal support with which limbs execute smooth and purposeful movement. Furthermore, as upper extremity functions are an integral component of daily living activities, exploring the association between trunk and upper extremity recovery will guide therapists in developing appropriate rehabilitation goals and interventions. The objectives of this study were to (1) assess the association between trunk and upper extremity recovery in the subacute stroke population and (2) assess the effect of trunk control on upper extremity impairment and function with age, gender, and duration of stroke as mediators using mediation analysis in subacute stroke individuals. Methods: This cross-sectional study included 54 subacute stroke participants with a mean age of 58.37 ± 6.11 years. The trunk impairment scale (TIS) assessed the trunk’s stability, mobility, and coordination. The level of upper extremity impairment was evaluated using the Fugl-Meyer Assessment scale (FMA). The quality and quantity of upper limb motor functions were measured using the Wolf motor function test (WMFT). Results: The TIS exhibited moderate positive correlations with the FMA-UE, WMFT-time scale (TS), and WMFT-functional ability scale (FAS) at p < 0.001. The mediation analysis reported a profound mediation effect of post-stroke duration on the association of trunk and upper limb recovery. Conclusions: The study results substantiated that trunk control significantly correlates with upper limb impairment and the quality and quantity of its use in the subacute stroke population. Post-stroke duration proved to mediate the association between trunk and upper limb recovery. Therefore, the assessment and intervention of trunk and upper extremity motor control considering the post-stroke duration is vital and should be incorporated in stroke rehabilitation aiming at functional independence.

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Section: Discussionmentioning

confidence: 98%

The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis

Gular

Sivasubramanian

Reddy

et al. 2022

IJERPH

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“…После курса комплексной МР отмечено значимое улучшение функциональной независимости по БИ. Эти результаты согласуются с предыдущими исследованиями, в которых установлено улучшение по ряду разделов БИ при использовании терапии, ограничиваю щей движение здоровой конечности (CIMT), по сравнению с обычной терапией [65].…”

Section: Discussionunclassified

Comprehensive rehabilitation of patients with post-stroke upper limb dysfunction: a randomized controlled trial

et al. 2022

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Introduction. The restoration of manipulative activity of the upper limb after an ischemic stroke (IS) requires the development of new technologies aimed at sensorimotor training and retraining. Reduction of spasticity of the upper limb muscles is considered as a necessary component of the program of functional restoration of the handAim. To evaluate the effectiveness and safety of the integrated use of rehabilitation technology with virtual reality and biofeedback “SENSOREHAB simulator glove” (RG) and botulinum neurotoxin type A (BTA) to restore the subject-manipulative function of the hand in comparison with an individual complex of physical therapy in the late recovery period of IS.Materials and methods. A randomized controlled trial included 76 patients, age 60.8 ± 9.2 years; the duration of the transferred IS was 8.1 ± 1.3 months. The main group (n = 42) received BTA with subsequent use of RP. The control group (n = 34) – individual physical therapy. The primary results were changes in the scores on the Fugl – Meyer scales (FMA–UL), the Action Research Arm Test (ARAT), the test with pegs and nine holes (NHPT). Secondary results: dynamics of MRCS, MAS, MoCA, HADS, Bartel index and quality of life (EuroQol-5D).Results. Improvement of the motor function of the arm in the main group according to ARAT (an increase of ≥4 points) was noted in 63.8% of cases, on the FMA–UL scale (an increase of ≥7 points in sections A–D) – in 65.5% of patients (p < 0.05), according to the NHPT test – a significant increase in the speed of execution The test was performed in 52.6% of patients. The dynamics of EQ-5D-5 (VAS) at the end of treatment reached 72.3 ± 5.7 in the main group (p = 0.03). In patients of the control group, a statistically significant improvement was noted in terms of pain and EQ-5D-5 (p < 0.05).Conclusions. A comprehensive program of medical rehabilitation of patients with post-stroke upper limb dysfunction, including the use of BTA and RG, significantly improves the recovery of fine hand movements, functional independence of patients and their quality of life.

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“…In one included study with two CIMT groups and one active control group, the active control group was included two times in meta-analysis comparisons. For each comparison, the sample size of the active control group was divided equally ( 15 ). Positive values of Hedges' g indicate effects in favor of CIMT or otherwise in favor of the active control.…”

Section: Methodsmentioning

confidence: 99%

“…With increasing evidence that CIMT improves lower limb outcomes in stroke survivors, meta-analysis is the optimal method to explore the influence of CIMT methods on the therapeutic effects of lower limbs. Two relevant meta-analysis reviews have been published ( 15 , 16 ). These studies divided articles into different subgroups based on outcome measures; Tedla et al ( 15 ) further split articles based on outcome measures and the CIMT method.…”

Section: Introductionmentioning

confidence: 99%

“…Two relevant meta-analysis reviews have been published ( 15 , 16 ). These studies divided articles into different subgroups based on outcome measures; Tedla et al ( 15 ) further split articles based on outcome measures and the CIMT method. The subgroup method reduced the number of studies and the power of statistical tests in the meta-analysis, leading to unexplained large heterogeneity ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

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Influence of the constraint-induced method of constraint-induced movement therapy on improving lower limb outcomes after stroke: A meta-analysis review

et al. 2023

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BackgroundConstraint-induced movement therapy (CIMT) targeting the lower limb function uses various methods. The influence of CIMT methods on lower limb outcomes after stroke has rarely been examined.ObjectivesThis study aimed to examine CIMT effects on lower limb outcomes and explore the influence of CIMT methods on treatment effects after stroke, with other potential factors considered as covariates.MethodsPubMed, Web of Science, Cochrane Library, Academic Search Premier via EBSCOHost, and PEDro databases were searched until September 2022. We included randomized control trials with CIMT targeting the lower limb function and dosage-matched active control. The Cochrane risk-of-bias tool was used to evaluate the methodological quality of each study. Hedges' g was used to quantify the effect size of CIMT on outcomes compared to the active control. Meta-analyses were conducted across all studies. A mixed-variable meta-regression analysis was used to investigate the influence of CIMT methods on treatment effects after stroke, with other potential factors considered as covariates.ResultsTwelve eligible randomized controlled trials with CIMT were included in the meta-analysis, where 10 trials were with a low risk of bias. A total of 341 participants with stroke were involved. For the treatment effects on the lower limb function, CIMT showed a moderate short-term effect size [Hedges' g = 0.567; P > 0.05; 95% confidence interval (CI): 0.203–0.931], but a small and insignificant long-term effect size (Hedges' g = 0.470; P > 0.05; 95%CI: −0.173 to 1.112), compared with conventional treatment. The CIMT method of using a weight strapped around the non-paretic leg and the ICF outcome category of the movement function were identified as significant factors contributing to the heterogeneity of short-term effect sizes across studies (β = −0.854 and 1.064, respectively, R2 = 98%, P > 0.05). Additionally, using a weight strapped around the non-paretic leg had a significant contribution to the heterogeneity of long-term effect sizes across studies as well (β = −1.000, R2 = 77%, P > 0.05).ConclusionConstraint-induced movement therapy is superior to conventional treatment for improvement of lower limb function in the short-term but not in the long-term. The CIMT method of using a weight strapped around a non-paretic leg contributed negatively to the treatment effect, and therefore might not be recommended.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021268681.

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Effectiveness of Constraint-Induced Movement Therapy (CIMT) on Balance and Functional Mobility in the Stroke Population: A Systematic Review and Meta-Analysis

Cited by 20 publications

References 40 publications

The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis

The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis

Comprehensive rehabilitation of patients with post-stroke upper limb dysfunction: a randomized controlled trial

Influence of the constraint-induced method of constraint-induced movement therapy on improving lower limb outcomes after stroke: A meta-analysis review

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