Effects of Lower Limb Constraint Induced Movement Therapy in People With Stroke: A Systematic Review and Meta-Analysis

Abstract

Background: Constraint induced movement therapy (CIMT) is effective at improving upper limb outcomes after stroke.Aim: The aim of this study was to carry out a systematic review and meta-analysis of the effects of lower limb CIMT studies of any design in people with stroke.Materials/ Method: PubMED, PEDro, OTSeeker, CENTRAL, and Web of Science were searched from their earliest dates to February 2021. Lower limbs CIMT studies that measured outcomes at baseline and post-intervention were selected. Sample size, mean, and standard deviation on the outcomes of interest and the protocols of both the experimental and control groups were extracted. McMaster Critical Review Form was used to assess the methodological quality of the studies.Result: Sixteen studies with different designs were included in this review. The result showed that lower limb CIMT improves functional, physiological and person's reported outcomes including motor function, balance, mobility, gait speed, oxygen uptake, exertion before and after commencement of activities, knee extensor spasticity, weight bearing, lower limb kinematics and quality of life in people with stroke post intervention. However, there were only significant differences in quality of life in favor of CIMT post-intervention [mean difference (MD) = 16.20, 95% CI = 3.30–29.10, p = 0.01]; and at follow-up [mean difference (MD) = 14.10, 95% CI = 2.07–26.13, p = 0.02] between CIMT and the control group. Even for the quality of life, there was significant heterogeneity in the studies post intervention (I2 = 84%, p = 0.01).Conclusion: Lower limb CIMT improves motor function, balance, functional mobility, gait speed, oxygen uptake, weigh bearing, lower limb kinematics, and quality of life. However, it is only superior to the control at improving quality of life after stroke based on the current literature.

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

“…Our findings were comparable to the conclusions of the study by Abdullahi et al [ 17 ], which focused exclusively on the effects of lower extremity CIMT on the stroke population, including multiple lower extremity functional components such as gait, lower extremity motor function, balance, functional mobility, and quality of life. Their effect size from the meta-analysis was 0.62 (95% CI [−0.54 to 1.78]) for balance and −0.53 (95% CI [−3.61 to 2.55]) for functional mobility, showing a statistically insignificant effect of lower extremity CIMT on both balance and functional mobility.…”

“…Previous reviews of CIMT involved many impairment measures, such as range of motion and spasticity, and activity measures, such as gait and upper and lower extremity function, though many did not consider the crucial components of balance and functional mobility [ 17 , 37 , 38 , 39 , 40 ]. The current systematic review with meta-analysis of RCTs is thus the first to focus on the effects of lower and upper extremity CIMT on balance in the stroke population.…”

“…Among the traditional approaches, CIMT was first developed for the upper extremity and consisted of constraining the unaffected upper extremity to improve the function of the paralyzed upper extremity [ 14 , 15 ]. Researchers have since further utilized CIMT for the lower extremity and trunk to improve motor function [ 16 , 17 , 18 , 19 , 20 ]. Despite being designed to improve upper extremity function, many researchers have surprisingly noted improvements in balance as well [ 21 , 22 , 23 ].…”

“…The previous systematic review focused on finding the effects of lower extremity CIMT on balance and functional mobility have provided positive effects in their systematic review; however, a meta-analysis could not show the significant effect size [ 17 ] and recommended to conduct a future meta-analysis including more studies. Hence, CIMT influence on balance is unclear, effect of upper extremity restraint on balance has not been fully explored, and the existence of ambiguity in this treatment technique requires further investigation.…”

Muscle Synergies and Clinical Outcome Measures Describe Different Factors of Upper Limb Motor Function in Stroke Survivors Undergoing Rehabilitation in a Virtual Reality Environment

“…In a study where muscle synergies were adopted to stratify stroke patients, synergies distributed coherently according to the Fugl-Meyer scale and Reaching Performance Scale, indicating that synergies convey similar underlying information [ 19 ]. Some other studies showed that muscle synergies and clinical scales were weakly correlated, and that stroke does not affect the inner structure of synergies, but rather their temporal recruitment [ 20 , 21 ]. There has also been evidence that synergies can improve in terms of their timing and organization by specific targeted therapies, including robot therapy or virtual reality treatment [ 15 , 22 , 23 ].…”