Impact of Constraint-Induced Movement Therapy (CIMT) on Functional Ambulation in Stroke Patients—A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Selection Criteria of Studies for This Review
2.2. Literature Search and Study Selection
2.3. Data Extraction
2.4. Evaluation of Methodological Quality and Level of Evidence
2.5. Risk of Bias Assessment
2.6. Data Synthesis
3. Results
3.1. Search Results
3.2. Characteristics of Included Studies
3.3. Outcome Measures
3.4. Methodological Quality and Level of Evidence
3.5. Quantitative Synthesis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Databases | PICO Format Search with Bullion Keywords (And) (OR) | |||
---|---|---|---|---|
Patient | Intervention | Comparison | Outcome | |
EBSCO, PubMed, PEDro, Science Direct, Scopus, MEDLINE, CINAHL, and Web of Science | Stroke OR Hemiplegia OR Hemiparesis OR Cerebrovascular accident | CIMT OR Constraint Induced Movement therapy OR Restricted Limb/Extremity OR Forced use | Proprioceptive Neuromuscular Facilitation OR PNF OR Neuro-Developmental Treatment R NDT OR Conventional Physical Therapy OR CPT OR Physiotherapy OR Exercise OR Or traditional rehabilitation OR Standard Physical Therapy | Gait speed OR Gait velocity OR Balance OR Center of Gravity OR Base of Support OR Center of Pressure OR Cardiovascular parameters OR Blood pressure OR percentage of heart rate maximum. |
Author/Year | Age | Chronicity | Intervention | Outcome Measures | Inferences | ||
---|---|---|---|---|---|---|---|
Experimental | Control | Duration | |||||
Aruin AS et al., 2012 | 57.7 ± 11.9 | Chronic | A shoe insert is provided on the unaffected side to shift body weight onto the affected side to promote muscle strength and weight-bearing capability. | The treatment encompasses the promotion of weight-bearing towards the affected side to promote balance and muscle strength. | 60 min per session, one session per week, six sessions in total, 6 h. | Symmetrical weight bearing, gait speed (m/s), BBS, Fugl-Meyer for lower extremity. | Post and follow-up retention were observed in the experimental group for symmetrical weight bearing, gait speed, and BBS in the experimental group. |
Bonnyaud C et al., 2013 | 50.03 ± 13.1 | Chronic | Treadmill training with ankle mass on non-paretic lower extremity. | Treadmill training. | 20 min, single session. | Cadence (steps/min), step length (cm), peak hip and knee flexion and dorsiflexion, vertical GRF (N/Kg), peak propulsion (N/Kg), peak breaking (N/Kg) gait speed (m/s). | The experimental and control group showed similar effects for gait variables. |
Bonnyaud C et al., 2014 | 50.6 5 ± 11.65 | Chronic | Asymmetrical gait training group: RAGT providing negative kinematic restraint applied to non-paretic lower extremity. | Symmetrical RAGT gait-training group. | 20 min, single session. | Symmetry ratio, stance time, double support time, static and dynamic GRF. | Peak knee flexion range was improved in the asymmetrical robotic raining group, and other gait variables improved equally among symmetrical and asymmetrical RAGT groups. |
Jung K et al., 2015 | 56.35 ± 14.1 | Subacute/chronic | Auditory feedback provided while walking with a cane in addition to standard therapy. | Walking with a cane in addition to standard therapy. | Gait training: 5 days per week for four weeks, 30 min per session. Standard therapy: Five days per week for four weeks, 30 min per session. | Gluteus medius and vastus medialis oblique muscle activity, single support phase of the affected side (% GC) vertical peak force of the cane (% BW) and gait speed (m/s). | The experimental group showed significant improvement in muscle activation and gait speed. |
Zhu Y et al., 2016 | 58.71 ± 6.02 | Subacute | Gait training consists of 2 h of sit-to-stand transfers, indoor walking, climbing up and down stairs, balance training and one-leg weight training with more repetitions in addition to this standard comprehensive rehabilitation. | Standard comprehensive rehabilitation treatment includes passive and active ROM exercises, stretching, balance and gait training. | Four weeks five days per week. | Step length (m), COM displacements, swing time (%gait cycle) step width(m), and gait speed(m/s). | m-CIMT gait training improved both COM displacements and spatio-temporal gait parameters. |
Ribeiro T et al., 2017 | 57.75 ± 3.75 | Subacute/chronic | Gait training on a treadmill, applying weight on the unaffected side. | Gait training on a treadmill. | The nine training sessions, 30 min, two consecutive weeks. | Step length, hip, knee and ankle ROM, and gait speed(m/s). | Spatio-temporal and kinematic gait parameters improved in both groups equally. |
e Silva EMG de S et al., 2017 | 57.75 ± 3.75 | Subacute/chronic | Gait training on a treadmill, applying weight on the unaffected side. | Gait training on a treadmill. | The nine training sessions, 30 min, two consecutive weeks. | BBS, stride time(s), TUG, symmetry ratio, stride width(m), turn speed(m/s), and stride length(m). | Spatio-temporal gait parameters balance and functional mobility improved in both groups equally. |
Candan SA et al., 2017 | 56.4 ± 13.45 | Subacute/chronic | m-CIMT includes intensive practice, restrain of non-paretic lower extremity and transfer package. | NDT program. | 120 min per session, five sessions per week for two weeks. | BBS, step length ratio, cadence (steps/min), postural symmetry FAC, and gait speed. | The m-CIMT group showed significant improvements on all variables when compared to the NDT group. |
Ribeiro T et al., 2017 | 57.75 ± 3.75 | Subacute/chronic | Gait training on a treadmill, applying weight on the unaffected side. | Gait training on a treadmill. | 30 min per session, nine training sessions for two consecutive weeks. | SPB (mmHg), DPB (mmHg), % of HR max, distance covered (m), gait speed (m/s). | Kinetic gait parameters improved in both groups equally. Restraint of a non-paretic limb did not show any effect. No changes have been observed in cardiovascular parameters between pre and post sessions. |
Ribeiro T et al., 2020 | 57.75 ± 3.75 | Subacute/chronic | Gait training on a treadmill, applying weight on the unaffected side. | Gait training on a treadmill. | The nine sessions, 30 min, two consecutive weeks. | Stance time(s), static and dynamic (GRF), double support time (s), symmetrical weight bearing, and symmetry ratio. | The experimental and control group showed similar effects for gait variables. |
Study ID | Eligibility Criteria | Random Allocation | Concealed Allocation | Baseline Comparability | Blinding of Participants | Blinding of Therapist | Blinding of Assessor | Adequate Follow-Up (>85%) | Intention to Treat | Between-Group Comparison | Point Estimates and Variability | Pedro Score (10) |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Aruin AS et al., 2012 | Y | Y | N | Y | N | N | N | × | N | Y | Y | 4 |
Bonnyaud C et al., 2013 | N | Y | N | Y | N | N | N | N | N | Y | Y | 4 |
Bonnyaud C et al., 2014 | N | Y | N | Y | N | N | N | N | N | Y | Y | 4 |
Jung K et al., 2015 | Y | Y | Y | Y | N | N | Y | Y | N | Y | Y | 7 |
Zhu Y et al., 2016 | Y | Y | N | Y | N | N | Y | N | N | Y | Y | 5 |
Ribeiro T et al., 2017 | Y | Y | Y | Y | N | N | Y | Y | Y | Y | Y | 8 |
e Silva EMG de S et al., 2017 | Y | Y | Y | Y | N | N | Y | Y | Y | Y | Y | 8 |
Candan SA et al., 2017 | Y | Y | N | Y | N | N | Y | Y | N | Y | Y | 6 |
Ribeiro T et al., 2017 | N | Y | N | Y | N | N | N | Y | N | Y | Y | 5 |
Ribeiro T et al., 2020 | Y | Y | Y | Y | N | N | Y | Y | Y | Y | Y | 8 |
Outcome Measures | Level of Evidence | Quality of the Studies | |
---|---|---|---|
Gait parameters | Gait speed | Level 1b | Good |
Cardiovascular parameters |
| Level 2 | Fair |
Balance |
| Level 1b | Good |
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Reddy, R.S.; Gular, K.; Dixit, S.; Kandakurti, P.K.; Tedla, J.S.; Gautam, A.P.; Sangadala, D.R. Impact of Constraint-Induced Movement Therapy (CIMT) on Functional Ambulation in Stroke Patients—A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2022, 19, 12809. https://doi.org/10.3390/ijerph191912809
Reddy RS, Gular K, Dixit S, Kandakurti PK, Tedla JS, Gautam AP, Sangadala DR. Impact of Constraint-Induced Movement Therapy (CIMT) on Functional Ambulation in Stroke Patients—A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2022; 19(19):12809. https://doi.org/10.3390/ijerph191912809
Chicago/Turabian StyleReddy, Ravi Shankar, Kumar Gular, Snehil Dixit, Praveen Kumar Kandakurti, Jaya Shanker Tedla, Ajay Prashad Gautam, and Devika Rani Sangadala. 2022. "Impact of Constraint-Induced Movement Therapy (CIMT) on Functional Ambulation in Stroke Patients—A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 19, no. 19: 12809. https://doi.org/10.3390/ijerph191912809