Therapeutic effect of adjuvant therapy added to constraint-induced movement therapy in patients with subacute to chronic stroke: a systematic review and meta-analysis

Abstract

Purpose

This review investigated the effectiveness of adjuvant therapy combined with constraint-induced movement therapy (CIMT) in improving the paretic upper limb functionality in adults with stroke sequelae during the subacute to chronic rehabilitation phase.

Materials and methods

In this systematic review and meta-analysis of randomized controlled trials (RCT), electronic databases, including PubMed, Web of Science, CINAHL, and MEDLINE, were searched. We included RCTs that investigated the outcomes of adjuvant therapy (i.e. other therapies) added to CIMT compared with CIMT alone. Key trial findings were qualitatively synthesized and analyzed. This meta-analysis examined variables, such as mean scores and standard deviations, using the following outcome measures: Fugl-Meyer Assessment (FMA) upper limb items, Action Research Arm Test (ARAT), Amount of Use (AOU) of Motor Activity Log (MAL), and Quality of Movement (QOM) of MAL.

Results

Eighteen eligible RCTs were included in the analysis. Adding CIMT to adjunctive therapy significantly improved FMA compared with CIMT alone (mean difference [MD] 4.02, 95% confidence interval [CI] 2.60–5.44; I² = 85%; 15 studies; 330 participants). Similarly, the ARAT and MAL-AOU scores improved significantly.

Conclusions

CIMT combined with several adjunctive therapies effectively improved upper limb function.

IMPLICATIONS FOR REHABILITATION

• In recent years, clinical trials combining other therapies with Constraint-induced movement therapy (CIMT) have become increasingly common.

• This study shows that combining CIMT with adjuvant therapy improves upper limb function.

• Different protocols of the CIMT in each study could be factor that impacted the results of Motor Activity Log.

• In clinical practice, the findings of this study into their treatment protocols to improve patient outcomes and ensure the effective application of evidence-based rehabilitation strategies.

Keywords:

• Stroke
• constraint-induced movement therapy (CIMT)
• adjuvant therapy
• upper extremity
• systematic review
• meta-analysis

Acknowledgements

I would like to extend my heartfelt gratitude to the researchers who generously provided the data for this systematic review. Their invaluable contributions were indispensable to the successful completion of this study. Additionally, we would like to express our appreciation to Editage (www.editage.jp) for their professional English language editing services.

Disclosure statement

The authors report that there are no competing interests to declare.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.