The effect and safety of constraint-induced movement therapy for post-stroke motor dysfunction: a meta-analysis and trial sequential analysis

Jiaming Zhang; Xianjun Xiao; Qizu Jin; Juan Li; Dongling Zhong; Yuxi Li; Yan Qin; Hong Zhang; Xiaobo Liu; Chen Xue; Zhong Zheng; Rongjiang Jin

doi:10.3389/fneur.2023.1137320

The effect and safety of constraint-induced movement therapy for post-stroke motor dysfunction: a meta-analysis and trial sequential analysis

Front Neurol. 2023 Apr 18:14:1137320. doi: 10.3389/fneur.2023.1137320. eCollection 2023.

Authors

Jiaming Zhang^#¹, Xianjun Xiao^#¹, Qizu Jin^#², Juan Li¹, Dongling Zhong¹, Yuxi Li¹, Yan Qin², Hong Zhang², Xiaobo Liu¹, Chen Xue¹, Zhong Zheng³, Rongjiang Jin¹

Affiliations

¹ School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
² The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China.
³ Center for Neurobiological Detection, West China Hospital of Sichuan University, Chengdu, Sichuan, China.

^# Contributed equally.

Abstract

Background: Due to motor function insufficiency, patients with post-stroke motor dysfunction (PSMD) have limitations in performing an activity, feel restricted during social participation, and feel impaired in their quality of life. Constraint-induced movement therapy (CIMT) is a neurorehabilitation technique, but its effectiveness on PSMD after stroke still remains controversial.

Objective: This meta-analysis and trial sequential analysis (TSA) aimed to comprehensively evaluate the effect and safety of CIMT for PSMD.

Methods: Four electronic databases were searched from their inception to 1 January 2023 to identify randomized controlled trials (RCTs) investigating the effectiveness of CIMT for PSMD. Two reviewers independently extracted the data and assessed the risk of bias and reporting quality. The primary outcome was a motor activity log for the amount of use (MAL-AOU) and the quality of movement (MAL-QOM). RevMan 5.4, Statistical Package for Social Sciences (SPSS) 25.0, and STATA 13.0 software were used for statistical analysis. The certainty of the evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. We also performed the TSA to assess the reliability of the evidence.

Results: A total of 44 eligible RCTs were included. Our results showed that CIMT combined with conventional rehabilitation (CR) was superior to CR in improving MAL-AOU and MAL-QOM scores. The results of TSA indicated that the above evidence was reliable. Subgroup analysis demonstrated that CIMT (≥6 h per day or duration ≤ 20 days) combined with CR was more effective than CR. Meanwhile, both CIMT and modified CIMT (mCIMT) combined with CR were more efficient than CR at all stages of stroke. No severe CIMT-related adverse events occurred.

Conclusion: CIMT may be an optional and safe rehabilitation therapy to improve PSMD. However, due to limited studies, the optimal protocol of CIMT for PSMD was undetermined, and more RCTs are required for further exploration.

Clinical trial registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=143490, identifier: CRD42019143490.

Keywords: constraint-induced movement therapy; meta-analysis; motor dysfunction; stroke; trial sequential analysis.

Publication types

Systematic Review

Grants and funding

This study was financially funded by (1) the Yibin Science and Technology Plan Project (grant no. 2022ZYD10) and (2) the Sichuan Science and Technology Program (grant no. 2019YFS0019).