Predicting shoulder function after constraint-induced movement therapy: a retrospective cohort study

ABSTRACT

Background Several predictors have been associated with upper extremity (UE) recovery after stroke, but characteristics that predict shoulder function after constraint-induced movement therapy (CIMT) have not yet been identified.

Objectives To identify predictors associated with satisfactory shoulder function in patients with reduced shoulder function at admission to CIMT.

Methods One hundred and seventy five patients were treated using CIMT while in a specialized inpatient hospital. Satisfactory shoulder function was defined according to the functional ability scale of the Wolf Motor Function test. Predictors of satisfactory shoulder function after CIMT were identified using multivariable logistic regression.

Results Better distal arm function and good proximal shoulder function on admission to CIMT were strong predictors of satisfactory shoulder function, while age and time of admission to CIMT since stroke were not. Seventeen percent of all CIMT-participants with reduced shoulder function pre-CIMT reached a level of satisfactory shoulder function after CIMT.

Discussion A substantial part of patients with reduced shoulder function reached a level of satisfactory shoulder function after CIMT. Intensive CIMT training, comprising tasks that require both distal and proximal UE function, may increase shoulder function in patients with a potential functional reserve.

KEYWORDS:

• Constraint-induced movement therapy
• CIMT
• stroke
• upper extremity
• shoulder

Abbreviations:

• UE – upper extremity
• CIMT – constraint-induced movement therapy
• WMFT – Wolf Motor Function test
• WMFTprox4 – Wolf Motor Function test sum-score of 4 items defining proximal function (shoulder function)
• WMFTdist4– Wolf Motor Function Test sum-score of 4 defining distal function (hand function)
• WMFT-FAS – Wolf Motor Function test – Functional Ability Scale

Acknowledgments

The authors would like to thank Peter Stubbs for providing comments on the manuscript.