A study of constraint-induced movement therapy in subacute stroke patients in Hong Kong

Objective: To investigate the beneficial effect of constraint-induced movement therapy in improving the function of hemiplegic upper extremity in the early subacute stroke patients. Design: A prospective, single-blinded, randomized controlled study comparing the effectiveness of constraint-induced movement therapy or control treatment at post intervention and 12 weeks follow-up. Subjects: The inclusion criteria were 2-16 weeks after stroke, hemiparesis of the affected limb, minimal function of >= 20 degrees wrist extension and >= 10 degrees extension of all digits and Mini-Mental State Examination score >= 17. Interventions: The intervention group underwent a programme of 10 days upper extremity training (4 hours per day) with the unaffected limb being restrained in a shoulder sling and the control group received an equivalent duration of conventional rehabilitation therapy. Main measures: Functional level for hemiparetic upper extremity, Motor Activity Log, Action Research Arm Test and modified Barthel Index. Results: There were 23 and 20 subjects respectively in the constraint-induced movement therapy and control groups. Significant improvements were seen at post intervention and 12 weeks after constraint-induced movement therapy in functional level for hemiparetic upper extremity (P=0.001), and in the 'amount of use' (P=0.001) and 'how well' (P=0.021) subscales of the Motor Activity Log. The total Action Research Arm Test score, grasp (P=0.004), grip (P=0.004), pinch (P=0.032) and gross (P=0.006) components showed significant improvement over the control group at post intervention. The grip component (P=0.019) and the total Action Research Arm Test score (P= 0.009) were superior to the control group at 12 weeks. Conclusion: Significant improvement in hand function could be achieved with constraint-induced movement therapy in subacute stroke patients, which was maintained up to 12 week follow-up.