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Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use [with consumer summary]
Brogardh C, Sjolund BH
Clinical Rehabilitation 2006 Mar;20(3):218-227
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: No; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: (1) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the demand on therapist resources. (2) To explore whether extended mitt use alone may enhance outcome. DESIGN: A combined case-control and randomized controlled study with pre- and post-treatment measures by blinded observers. SETTING: A university hospital rehabilitation department. PARTICIPANTS: Sixteen stroke patients (nine men and seven women; mean age 56.7 years; on average 28.9 months post stroke, five of whom were 6 to 9 months post stroke) with moderate motor impairments in the contralateral upper limb. INTERVENTION: Constraint-induced therapy (mitt on the less affected hand 90% of waking hours for 12 days) with 2 to 3 patients per therapist and 6 h of group training per day. After the training period, the patients were randomized either to using the mitt at home every other day for two-week periods for another three months (in total 21 days) or to no further treatment. OUTCOME MEASURES: Modified Motor Assessment Scale, Sollerman Hand Function Test, Two-Point Discrimination test and Motor Activity Log. RESULTS: The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale (1.44 (95% confidence interval (95% CI) 0.59 to 2.28) points; p = 0.003) and on Sollerman Hand Function Test (3.81 (95% CI 0.26 to 7.36) points; p = 0.037) but showed no sensory change in the Two-Point Discrimination Test (p = 0.283). The median difference in self-reported motor ability (Motor Activity Log) also improved (p < 0.001). However, no additional effect was seen from wearing a mitt for another three months. CONCLUSION: Constraint-induced group therapy, allowing several patients per therapist, seems to be a feasible alternative to improve upper limb motor function. The restraint alone, extended in time, did not enhance the treatment effect.

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