Long-term Benefit of CIMT

October 2015 Journal Club: Takebayashi T, Amano S, Hanada K, Umeji A, Takahashi K, Marumoto K, Kodama N, Koyama T and Domen K (2015) A one-year follow-up after modified constraint-induced movement therapy for chronic stroke patients with paretic arm: a prospective case series study. Topics in Stroke Rehabilitation, 22(1), 18-25, DOI http://dx.doi.org/10.1179/1074935714Z.0000000028

Background and purpose: Despite the confirmed short-term effects of constraint-induced movement therapy, the long-term effects have not been sufficiently verified in terms of functional improvement of the affected arm

Method: At 1 year after completing modified constraint-induced movement therapy, arm function (Fugl-Meyer Assessment) and amount of daily arm use (motor activity log) were assessed.

Results: Fourteen post-stroke patients with mild to moderate impairment of arm function were analyzed. One year after completing modified constraint-induced movement therapy, participants consistently showed improvements in arm function and amount of daily arm use (analysis of variance: Fugl-Meyer Assessment, P < 0.001; Motor Activity Log, P < 0.001). For the Fugl-Meyer Assessment, post-hoc tests detected significant improvements (pre versus post, P = 0.009; pre versus 1 year, P < 0.0001; post versus 1 year, P < 0.036). For the Motor Activity Log, post-hoc tests also detected significant improvements (pre versus post, P = 0.0001; pre versus 1 year, P < 0.0001; post versus 1 year, P = 0.0014). The magnitude of the change in Fugl-Meyer Assessment score correlated significantly with the change in Motor Activity Log score (R = 0.778, P = 0.001).

Conclusion: Among post-stroke patients with mild to moderate impairments of arm function, modified constraint-induced movement therapy without any other rehabilitation after intervention may improve arm function and increase arm use for 1 year. In addition, increasing arm use may represent an important factor in improving arm function, and vice versa.

2 thoughts on “Long-term Benefit of CIMT

  1. Hi Isobel
    Thanks for your blog. I am reviewing the evidence for introduction of mCIMT for chronic stroke survivors, particularly those who live at home. I struggle to share your confidence about sufficient evidence to introduce this into practice. Most of the studies have insufficient sample sizes to give required power, which I understand has a tendency to exaggerate the positive effect. The latest Cochrane review (2015) was less positive than an earlier one (Sirtori, 2009). As you say so much research has gone into this (I have read so many articles about it!) but it seems to me that the best evidence is not so conclusive. Perhaps this is why therapists are slow to take it up? CIMT is included in our Australian and the more recent UK stroke guidelines yet when I do an analysis of the literature I am struggling to find conclusive evidence to introduce it into my remote practice…where OT resources are lower than most metropolitan areas. I started out being very keen to introduce it as a home based therapy, particularly given Barzel’s recent research in 2015, as I believe people in rural areas must have the same opportunities for optimising occupational performance post stroke but now I am not convinced that we should be using hours for this – currently we do not provide therapy in our outreach, so to introduce it we would have to cut something back. I’m thinking that perhaps if we already provided another therapy, then there would be evidence for clients for whom it was indicated to substitute mCIMT with another therapy- or if we had another therapist we might introduce it. Colleagues in a nearby stroke unit support its introduction so maybe I’m missing something. Maybe the evidence doesn’t have to be conclusive-just indicatory? I would welcome your comment.
    Cheers, Robyn


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