Table 4

Results of both effectiveness and feasibility studies

AuthorsMeasurement time pointsOutcome measure, primary (P) or secondary (S)Results: intervention groupResults: comparator group (1)Results: comparator group (2)Results between groups (difference or ES (95% CI; p value))Feasibility outcomeMeasurementsResults
James et al31 (CA), 32 (CA), 76Baseline and after intervention (20 weeks).Computer rehabilitation and virtual reality.Care as usual.
AMPS, P.AMPS-M 0.32 (0.7)
AMPS-P 0.34 (0.6)		AMPS-M
−0.03 (0.7)
AMPS-P −0.07 (0.8)		AMPS-M
0.28 (0.17 to 0.39; p≤0.001)
AMPS-P
0.30 (0.19 to 0.41; p≤0.001)
AHA, P.1.56 (22.6)1.78 (22.5)0.81 (−1.46 to 3.08; p=0.478)
JTHFT, P.Impaired upper limb −28.47 (254.8)
Dominant upper limb −4.81 (12.2)		Impaired upper limb −19.06 (253.7)
Dominant upper limb 1.28 (28.2)		Impaired upper limb
−22.03 (−44.78 to 0.72; p=0.058)
Dominant upper limb
−4.68 (−7.39 to −1.98; p<0.001)
MA, P.−0.07 (25.4)−0.81 (23.9)1.48 (−4.11 to −1.15; p=0.265)
COPM, S.COPM performance 2.11 (2.2)
COPM satisfaction 2.08 (2.4)		COPM performance 0.76 (1.9)
COPM satisfaction 0.58 (2.4)		COPM performance
1.29 (0.73 to 1.85; p≤0.001)
COPM satisfaction 1.45 (0.44 to 0.83; p≤0.001)
During intervention period.ICompliance.Participants in the intervention group completed an average of 32.4 hours of Mitii (range 3.7–74.7 hours).
Hoare et al75At baseline (1–2 weeks before injection), and at 1 month, 3 months and 6 months after injection.mCIMT.Other home-based training programme.
AHA, P.EMD (95% CI)
3 months–baseline 5.6 (3.3 to 7.9)
6 months–baseline 5.5 (3.1 to 7.8)		EMD (95% CI)
3 months–baseline 4.8 (2.5 to 7.1)
6 months–baseline 6.0 (3.7 to 8.4)		EMD (upper limit 95% CI)
3 months–baseline 0.8 (3.6; p=0.32)
6 months–baseline −0.6 (2.3; p=0.36)
QUEST, S.EMD (95% CI)
QUEST grasp
3 months–baseline 6.1 (0.0 to 12.3)
6 months–baseline 8.1 (3.2 to 13.1)
QUEST dissociated movement
3 months–baseline 3.4 (4.3 to 11.0)
6 months–baseline 2.6 (9.1 to 3.8)		EMD (95% CI)
QUEST grasp
3 months–baseline 5.1 (–1.0 to 11.3)
6 months–baseline 2.3 (2.6 to 7.3)
QUEST dissociated movements
3 months–baseline 3.3 (4.3 to 11.0)
6 months–baseline 4.0 (2.4 to 10.4)		EMD (upper limit 95% CI)
QUEST grasp
3 months–baseline 1.0 (8.3; p=0.41)
6 months–baseline 5.8 (11.6; p=0.05)
QUEST dissociated movements
3 months–baseline 0.0 (9.1; p=0.50)
6 months–baseline −6.6 (0.9; p=0.07)
Self-care domain of PEDI, S.PEDI functional skills
3 months–baseline 10.3 (7.4–13.2)
6 months–baseline 11.2 (7.6–14.7)
PEDI caregiver assistance
3 months–baseline 9.6 (5.3–13.9)
6 months–baseline 10.4 (3.8–16.9)		PEDI functional skills
3 months–baseline 7.3 (4.4–10.2)
6 months–baseline 11.4 (7.8–15.0)
PEDI caregiver assistance
3 months–baseline 9.0 (4.7–13.3)
6 months–baseline 12.1 (5.6–18.7)		PEDI functional skills
3 months–baseline 3.0 (6.6; p=0.08)
6 months–baseline −0.2 (4.1; p=0.47)
PEDI caregiver assistance
3 months–baseline 0.6 (5.7; p=0.42)
6 months–baseline −1.8 (6.0; p=0.35)
COPM, S.COPM performance
3 months–baseline 3.3 (2.5–4.1)
6 months–baseline 3.2 (2.5–4.0)
COPM satisfaction
3 months–baseline 3.3 (2.4–4.1)
6 months–baseline 3.3 (2.5–4.2)		COPM performance
3 months–baseline 3.0 (2.2–3.8)
6 months–baseline 3.2 (2.4–3.9)
COPM satisfaction
3 months–baseline 3.0 (2.1–3.9)
6 months–baseline 3.2 (2.4–4.1)		COPM performance
3 months–baseline 0.3 (1.2; p=0.30)
6 months–baseline 0.1 (1.0; p=0.45)
COPM satisfaction
3 months–baseline 0.3 (1.6; p=0.33)
6 months–baseline 0.1 (1.1; p=0.45)
GAS, S.Cannot be calculated.Not provided.
During intervention period.IThe amount of home therapy undertaken.There was a difference between groups in the intensity of home programme (mean hours: BoNT- A+mCIMT 98.5; BONT-A+BOT 31.6). Children in the BoNT- A+mCIMT group wore the restraint mitt (therapy sessions and home programme) for a mean of 98.5 (SD 32) hours of the expected 168 hours.
Kirkpatrick et al77Baseline, 3 months and 6 months (3 months after intervention).Play-based action observation with repeated practice.Other home-based training programme.
AHA, P.Mean (95% CI)
3 months–baseline 2.2 (1.3 to 3.1)
6 months–baseline 1.7 (0.2 to 3.3)		Mean (95% CI)
3 months–baseline 1.6 (0.6 to 2.6)
6 months–baseline 1.2 (0.4 to 2.7)		No effect size.
MA-2, S.Mdn (95% CI)
ROM
3 months–baseline 7.4 (4.4 to 10.7)
6 months–baseline 3.7 (0.0 to 14.8)
ACC
3 months–baseline 4.8 (1.2 to 12.0)
6 months–baseline 4.7 (4.0 to 12.7)
FLU
3 months–baseline 2.4 (0.6 to 9.5)
6 months–baseline 2.4 (1.4 to 14.3)
DEX
3 months–baseline 8.8 (3.1 to 18.8)
6 months–baseline 10.1 (6.3 to 18.8)		Mdn (95% CI) ROM
3 months–baseline 7.4 (3.7 to 11.8)
6 months–baseline 3.7 (0.2 to 13.7)
ACC
3 months–baseline 5.9 (5.0 to 16.1)
6 months–baseline 4.0 (0.0 to 14.7)
FLU
3 months–baseline 4.8 (2.4 to 11.9)
6 months–baseline 9.5 (2.4 to 14.3)
DEX
3 months–baseline 0.0 (0.0 to 12.5)
6 months–baseline 6.7 (3.1 to 15.6)		No effect size.
ABILHAND-Kids, S.Mdn (95% CI)
3 months–baseline 0.67 (0.2 to 1.7)
6 months–baseline 0.50 (0.9 to 1.7)		Mdn (95% CI)
3 months–baseline 0.67 (0.4 to 1.4)
6 months–baseline 0.74 (0.5 to 1.4)		No effect size.
During intervention period.ICompliance through therapy diaries.42 therapy diaries were returned (22 from the AO+RP group). The mean number of play sessions was 48.2 (19.3) in the therapy group and 54.8 (23.1) in the control group. Compliance data showed that 62% of the children who returned therapy diaries achieved this dose, while 78% achieved or exceeded 1 hour per week of therapy.
Gordon et al85Pretest and post-test, and 1-month and 6-month follow-up.mCIMT.Other home-based training programme.
AHA, P.Post-test–pretest 0.42
1-month follow-up–pretest 0.52
6-month follow-up–pretest 0.67		Post-test–pretest 0.56
1-month follow-up–pretest 0.60
6-month follow-up–pretest 0.61		Not provided.
JTHFT, P.Post-test–pretest
−141.7
1-month follow-up–pretest
−167.7
6-month follow-up pretest −153.8		Post-test–pretest
−131.2
1-month follow-up–pretest
−143.9
6-month follow-up pretest −158.1		Not provided.
QUEST, S.Dissociated movement
Post-test–pretest 5.1
1-month follow-up–pretest 6.1
6-month follow-up–pretest 3.9
Grasp
Post-test–pretest 11.1
1-month follow-up–pretest 11.7
6-month follow-up–pretest 9.3		Dissociated movement
Post-test–pretest 3.5
1-month follow-up –pretest 3.1
6-month follow-up–pretest 3.2
Grasp
Post-test–pretest 10.8
1-month follow-up–pretest 11.3
6-month follow-up–pretest 7.6		Not provided.
GAS, S.Cannot be calculated.Not provided.
Activity monitor on the wrists, S.Post-test–pretest 12.3
1-month follow-up–pretest 12.5
6-month follow-up–pretest 13.7		Post-test–pretest 15.2
1-month follow-up–pretest 13.3
6-month follow-up–pretest 14.7		Not provided.
During intervention period.ICompliance with home-based training.Home logs indicated that children averaged 286 min of the requested 360 min/week engaging in home practice during the 6 months following the intervention.
Wallen et al33 (CA), 86Baseline, 10 weeks and 6 months following randomisation.mCIMT.Other home-based training programme
COPM, P.COPM performance
10-week–baseline 3.6 (2.5)
6-month–baseline 4.3 (2.1)
COPM satisfaction 10-week–baseline 3.8 (2.8)
6-month–baseline 4.5 (2.5)		COPM performance
10-week–baseline 3.1 (2.0)
6-month–baseline 3.9 (1.9)
COPM satisfaction
10-week–baseline 3.3 (3.2)
6-month–baseline 3.8 (3.0)		COPM performance
10-week–baseline 0.3 (−0.8 to 1.4; p=0.61)
6-month–baseline 0.2 (−0.7 to 1.2; p=0.65)
COPM satisfaction
10-week– baseline 0.1 (−1.1 to 1.2; p=0.90)
6-month–baseline 0.3 (−0.7 to 1.4; p=0.50)
GAS, S.10–week–baseline 2.5 (0.9)
6-month–baseline 2.9 (0.9)		10-week–baseline 2.5 (0.8)
6-month–baseline 2.8 (0.8)		10-week–baseline 0.0 (−0.5 to 0.5; p=0.88)
6-month–baseline 0.2 (−0.3 to 0.7; p=0.51)
AHA, S.10 week–baseline 2.3 (41.8)
6-month–baseline 7.3 (39.7)		10-week–baseline 2.2 (42.2)
6-month–baseline 4.7 (40.9)		10-week–baseline 1.0 (−3.8 to 5.8; p=0.68)
6-month–baseline 4.3 (−1.3 to 9.8; p=0.13)
PMAL-R, S.How often
10-week–baseline 10.4 (26.4)
6-month–baseline 14.4 (25.3)
How well
10-week–baseline 17.2 (32.1)
6-month–baseline 19.7 (31.3)		How often
10-week–baseline 12.8 (23.4)
6-month–baseline 14.9 (22.6)
How well
10-week–baseline 12.9 (26.2)
6-month–baseline 15.2 (23.2)		How often
10-week–baseline −0.2 (−8.7 to 8.2; p=0.95)
6-month–baseline 2.0 (−5.8 to 9.8; p=0.62)
How well
10-week–baseline 5.2 (−3.8 to 14.2; p=0.25)
6-month–baseline 5.9 (−2.7 to 14.6; p=0.18)
(MAS), S.MAS elbow flexors
10-week–baseline −0.1 (1.0)
6–month–baseline −0.2 (1.2)
MAS pronators
10-week–baseline 0.2 (0.8)
6-month–baseline 0.1 (0.9)
MAS wrist flexors
10-week–baseline −0.1 (0.8)
6-month–baseline 0.0 (0.9)		MAS elbow flexors
10-week–baseline 0.0 (1.1)
6-month–baseline 0.0 (0.9)
MAS pronators
10-week–baseline 0.2 (1.0)
6-month–baseline 0.1 (0.9)
MAS wrist flexors
10-week–baseline 0.0 (0.8)
6-month–baseline 0.0 (0.8)		Not provided.
Modified Tardieu Scale, S.Tardieu elbow flexors
10-week–baseline 4.6 (42.2)
6-month—baseline −0.5 (47.8)
Tardieu pronators
10-week–baseline 1.9 (42.6)
6-month–baseline −8.1 (50.9)
Tardieu wrist flexors
10-week–baseline 10.3 (29.1)
6-month–baseline 3.1 (35.2)		Tardieu elbow flexors
10-week–baseline −1.4 (46.0)
6-month–baseline 1.3 (48.9)
Tardieu pronators
10-week–baseline 2.6 (50.3)
6-month–baseline −6.6 (49.8)
Tardieu wrist flexors
10-week–baseline 0.4 (30.1)
6-month–baseline −6.9 (35.1)		Tardieu elbow flexors
10-week–baseline 8.7 (−6.8 to 24.1; p=0.26)
6-month– baseline 1.0 (−18.7 to 20.8; p=0.92)
Tardieu pronators 10-week–baseline 2.6 (−14.8 to 20.1; p=0.76)
6-month–baseline 2.4 (−18.9 to 23.7; p=0.82)
Tardieu wrist flexors
10-week–baseline 6.1 (−5.9 to 18.2; p=0.31)
6-month–baseline 6.6 (−9.5 to 22.7; p=0.41)
During intervention period.IDaily log of the amount of time the constraint was worn (mCIT group) and the nature of intervention and time spent completing therapy
(both groups).		Most parents (75%) did not find it easy to carry out this intervention. The majority, however, reported that they felt mCIT was worthwhile (96%) and would consider implementing it again (76%).
Time mitt worn as % of total time expected (112 hours) (n=22): mean (SD) 67.2 (27.7), range 21–113.
Therapy completed during intervention, hours per day: mCIMT mean (SD) 1.3 (0.6), range 0.4–2.3; intensive occupational therapy mean (SD) 0.8 (0.6), range 0.3–2.6.
Before the 10-week assessment.AAdverse events were monitored via a semistructured interview with each parent.Number of children experiencing adverse events: mCIMT 5 of 25, intensive occupational therapy 1 of 25. Adverse events were minor, were related to participants’ lack of acceptance of constraints of therapy, and manifested as frustration and refusal to cooperate.
Al-Oraibi and Eliasson72 mCIMT.NDT.
Pretest and post-test (8 weeks).AHA, P.6.4 (17.2)0.6 (26.5)ES=1.5
During intervention period.ICompliance with training with diary notes.Compliance varied, since some families found it difficult to engage the children in activities at home, while others found it easy. The children wore the restraint glove for a mean of 92.2 (SD 29.2) hours of the expected 96 hours. Children only received training for 56.6 (SD 25.7) hours of the expected 96 hours. The attendance varied between 5 and 8 sessions with a mean of 7.3 (SD 1.3) of the expected 8 hours.
Not specified.AOpen interviews: therapists’ experiences performing the treatment and reactions of the families.Several of the children needed some time to adjust to wearing the glove both at home and in the therapy sessions. Both therapists and parents found the parental involvement in the planning of training meaningful. Several mothers reported that they were motivated to continue the programme since they could see the difference in their children.
Eugster-Buesch et al73 Forced use therapy.Care as usual.
Baseline (2 weeks prior to the intervention), pretest, post-test, and 2-week, 3-month and 12-month follow-up.MA, P.Post-test–baseline 1.93 (4.86)Post-test–baseline −0.05 (3.74)ES=0.46 (−1.94 to 5.90; p=0.304)
At the end of the 3-month follow-up.AStructured 43-item questionnaire with parents about compliance and participation.72% (8 of 11) of the participants reported having always or often reached the 6 hours/day specified splint wearing. 60% (6 of 10) of the parents indicated that wearing the splint had been a tedious matter. Refusal to wear the splint was observed in 54% (6 of 11) of children. Frustration in regard to accomplishing certain activities was observed rarely in 64% (7 of 11). Playtime occurred mainly within the family structure, whereby parents played a very important role, as 82% indicated having played always with their children. 73% (8 of 11) of parents indicated that daily routine and activities were successfully integrated into the daily forced use time span. 55% (6 of 11) of parents stated that the forced use period had been exhausting.
Hsin et al74 mCIMT.Other home-based training programme.
Pretest and post-test at 3-month follow-up.Subtest 8 of BOTMP, P.Post-test–pretest 5.4 (2.1)
3-month follow-up–pretest 7.4 (2.1)		Post-test–pretest 4.4 (1.5)
3-month follow-up–pretest 5.7 (1.8)		Post-test–pretest ES=0.470 (p=0.001)
3-month follow-up–pretest
ES=0.462 (p=0.001)
PMAL, S.AOU
Post-test–pretest 0.7 (0.4)
Follow-up–pretest 1.1 (0.4)
QOU
Post-test–pretest 0.5 (0.4)
Follow-up–pretest 1.1 (0.4)		AOU
Post-test–pretest 0.5 (0.5)
Follow-up–pretest 0.9 (0.5)
QOU
Post-test–pretest 0.4 (0.4)
Follow-up–pretest 0.8 (0.4)		AOU
Post-test–pretest ES=0.438 (p=0.001)
3-month follow-up–pretest
ES=0.233 (p=0.027)
QOU
ES=0.415 (p=0.002)
3-month follow-up–pretest
ES=0.237 (p=0.025)
Cerebral Palsy-Specific Quality of Life (parent-proxy version), S.Social well-being and acceptance domain
Post-test–pretest 9.4 (5.5)
Follow-up–pretest 14.5 (5.0)
Functioning domain
Post-test–pretest 12.0 (14.0)
Follow-up–pretest 13.8 (12.0)
Participation and physical health domain
Post-test–pretest 8.3 (18.6)
Follow-up–pretest 11.7 (17.0)
Emotional well-being and self-esteem domain
Post-test–pretest 12.2 (15.4)
Follow-up–pretest 14.8 (13.3)
Pain and impact of disability domain
Post-test–pretest 11.9 (23.7)
Follow-up–pretest 19.4 (22.2)
Access to service domain
Post-test–pretest 9.5 (12.2)
Follow-up–pretest 14.5 (13.6)
Family health domain
Post-test–pretest 10.8 (18.4)
Follow-up–pretest 14.5 (15.3)		Social well-being and acceptance domain
Post-test–pretest 6.3 (9.1)
Follow-up–pretest 10.1 (7.4)
Functioning domain
Post-test–pretest 8.6 (8.8)
Follow-up–pretest 11.6 (7.4)
Participation and physical health domain
Post-test–pretest 8.7 (10.0)
Follow-up–pretest 12.1 (9.2)
Emotional well-being and self-esteem domain
Post-test–pretest 8.5 (7.7)
Follow-up–pretest 12.5 (6.8)
Pain and impact of disability domain
Post-test–pretest 10.2 (22.6)
Follow-up–pretest 14.4 (20.0)
Access to service domain
Post-test–pretest 8.9 (13.6)
Follow-up–pretest 11.6 (12.6)
Family health domain
Post-test–pretest 9.9 (8.9)
Follow-up–pretest 12.8 (7.2)		Social well-being and acceptance domain
Post-test–pretest ES=0.147 (p=0.086)
Follow-up–pretest
ES=0.366 (p=0.004)
Functioning domain
Post-test–pretest ES=0.074
(p=0.234)
Follow-up–pretest
ES=0.236 (p=0.026)
Participation and physical health domain
Post-test–pretest
ES=0.046 (p=0.350)
Follow-up–pretest
ES=0.180 (p=0.056)
Emotional well-being and self-esteem domain
Post-test–pretest
ES=0.071 (p=0.244)
Follow-up–pretest
ES=0.326 (p=0.007)
Pain and impact of disability domain
Post-test–pretest ES=0.045 (p=0.356)
Follow-up–pretest
ES=0.323 (p=0.007)
Access to service domain
Post-test–pretest ES=0.000 (p=0.925)
Follow-up–pretest
ES=0.289 (p=0.012)
Family health domain
Post-test–pretest ES=0.042 (p=0.373)
Follow-up–pretest
ES=0.136 (p=0.100)
During intervention period.IThe number of restraint hours outside therapy in daily logs.The average constraint time in constraint-induced therapy group is 3.5 (SD 0.1) hours, ranging from 3.3 to 3.8 hours/day.
Klingels et al78 mCIMT.Other home-based training programme.
Baseline, after intervention and after 10-week follow-up.AHA, P.Post-test–baseline 4.2 (20.6)
Follow-up–baseline 3.7 (20.8)		Post-test–baseline 2.0 (21.0)
Follow-up–baseline 1.9 (22.1)		No effect size.
MAS, S.Post-test–baseline −0.7 (3.7)
Follow-up–baseline −0.78 (4.0)		Post-test–baseline −1.81 (3.5)
Follow-up–baseline −1.28 (3.3)		No effect size.
MMT, S.Mdn
Post-test–baseline 0.5
Follow-up–baseline 2.0		Mdn
Post-test–baseline 2.0
Follow-up–baseline 1.2		No effect size.
Maximum contraction recorded with a Jamar dynamometer, S.Post-test–baseline 0.05 (5.1)
Follow-up–baseline 0.65 (5.3)		Post-test–baseline −0.12 (4.5)
Follow-up–baseline 0.22 (3.8)		No effect size.
MA, S.Mdn
Post-test–baseline 5.7
Follow-up–baseline 6.5		Mdn
Post-test–baseline 5.7
Follow-up–baseline 5.3		No effect size.
JTHFT, S.Mdn
Post-test–baseline −77
Follow-up–baseline −94		Mdn
Post-test–baseline −92
Follow-up–baseline −97		No effect size.
ABILHAND-Kids, S.Post-test–baseline 0.43 (1.9)
Follow-up–baseline 0.39 (2.2)		Post-test–baseline 0.35 (2.0)
Follow-up–baseline 0.21 (2.1)		No effect size.
During intervention period.ICompliance recorded with an activity log.Mean time spent wearing the constraint was 39 hours 30 min (SD 12 hours) in the mCIMT group and 39 hours 15 min (SD 14 hours) in the mCIMT+IT group. In the mCIMT group, 15 out of 23 children wore the splint for more than 80% of the expected time (>40 hours). For the mCIMT+IT group, a compliance of more than 80% was reached in 17 out of 25 children. Children in the mCIMT+IT group received a mean therapy time of 20 hours 30 min (SD 3 hours). 22 out of 25 children received more than 80% of the expected therapy sessions (>18 hours).
Lin et al79 mCIMT.Other home-based training programme.
Pretest and post-test, and 6-month follow-up.PDMS-2 of the more-affected upper extremity, P.PDMS-G, grasping subscale
Post-test–pretest 3.4 (12.4)
Follow-up–pretest 3.9 (12.2)
PDMS-V, visual motor integration subscale
Post-test–pretest 7.1 (38.6)
Follow-up–pretest 11.1 (37.6)		PDMS-G, grasping subscale
Post-test–pretest 0.72 (8.8)
Follow-up–pretest 0.45 (8.7)
PDMS-V, visual motor integration subscale
Post-test–pretest 5.45 (33.3)
Follow-up–pretest 6.09 (33.2)		PDMS-G, grasping subscale
Post-test–pretest ES=0.252 (p=0.012)
Follow-up–pretest
ES=0.155 (p=0.043)
PDMS-V, visual motor integration subscale
Post-test–pretest ES=0.023 (p=0.254)
Follow-up–pretest
ES=0.051 (p=0.163)
BOTMP, P.Subtest 8
Post-test–pretest 3.45 (12.0)
Follow-up–pretest 1.85 SD (11.5)
More affected upper extremity
Post-test–pretest 4.05 (7.2)
Follow-up–baseline 3.25 (7.1)
Bilateral coordination
Post-test–pretest 0.85 (4.1)
Follow-up–pretest 0.05 (3.9)		Subtest 8
Post-test–pretest −0.23 (13.2)
Follow-up–pretest −0.32 (13.8)
More affected upper extremity
Post-test–pretest 0.95 (8.6)
Follow-up–baseline 0.77 (8.8)
Bilateral coordination
Post-test–pretest 0.09 (3.2)
Follow-up–pretest 0.19 (3.5)		Subtest 8
Post-test–pretest
ES=0.230 (p=0.033)
Follow-up–pretest
ES=0.045 (p=0.369)
More affected upper extremity
ES=0.378 (p=0.002)
Follow-up– pretest
ES=0.100 (p=0.088)
Bilateral coordination
ES=0.145 (p=0.049)
Follow-up– pretest
ES<0.001 (p=0.482)
PMAL, S.Amount of use
Post-test–pretest 1.1 (1.4)
Follow-up–pretest 1.49 (1.3)
Quality of use
Post-test–pretest 0.67 (1.3)
Follow-up–pretest 1.00 (1.2)		Amount of use
Post-test–pretest 0.26 (1.2)
Follow-up–pretest 0.43 (1.4)
Quality of use
Post-test–pretest 0.19 (1.0)
Follow-up–pretest 0.13 (1.1)		Amount of use
Post-test–pretest
ES=0.354 (p=0.003)
Follow-up–pretest
ES=0.201 (p=0.024)
Quality of use
Post-test–pretest
ES=0.184 (p=0.030)
Follow-up–pretest
ES=0.317 (p=0.005)
CFUS, S.Amount of use
Post-test–pretest 0.65 (1.4)
Follow-up–pretest 1.19 (1.3)
Quality of use
Post-test–pretest 0.58 (1.5)
Follow-up–pretest 0.81 (1.3)		Amount of use Post-test–pretest 0.44 (1.4)
Follow-up–pretest 0.37 (1.3)
Quality of use Post-test–pretest 0.25 (1.2)
Follow-up–pretest 0.4 (1.1)		Amount of use Post-test–pretest
ES=0.037 (p=0.210)
Follow-up–pretest
ES=0.308 (p=0.006)
Quality of use
Post-test–pretest ES=0.067 (p=0.128)
Follow-up–pretest
ES=0.181 (p=0.027)
PSI-SF (parent-related), S.Parental distress
Post-test–pretest −0.7 (9.5)
Follow-up–pretest −1.3 (10.5)
Parent–child dysfunctional interaction
Post-test–pretest 3.9 (7.9)
Follow-up–pretest −2.00 (7.6)
Difficult child
Post-test–pretest 1.55 (7.3)
Follow-up–pretest −4.25 (10.9)		Parental distress
Post-test–pretest −0.4 (9.6)
Follow-up–pretest −1.77 (9.7)
Parent–child dysfunctional interaction
Post-test–pretest −2.82 (11.6)
Follow-up–pretest −0.73 (12.6)
Difficult child
Post-test–pretest −3.64 (10.7)
Follow-up–pretest −5.00 (10.2)		Parental distress
Post-test–pretest ES<0.001 (p=0.996)
Follow-up– pretest
ES=0.013 (p=0.627)
Parent–child dysfunctional interaction
Post-test–pretest ES=0.235 (p=0.030)
Follow-up– pretest
ES=0.043 (p=0.378)
Difficult child
Post-test–pretest ES=0.057 (p=0.299)
Follow-up– pretest
ES=0.007 (p=0.724)
During intervention period.ICompliance with daily restraint, documented by parents in daily logs.CIT: 31.69±14.05 hours; control group: 28.24±16.55 hours.
Novak et al81 OTHP.No therapy.Other home-based training programme.
Baseline, at 4 weeks and at 8 weeks.COPM, P.Cannot be calculated.COPM performance
4 weeks–baseline ES=0.2 (0.1 to 0.3; p=0.01)
8 weeks–baseline ES=1.4 (0.6 to 2.2; p=0.01)
COPM satisfaction
4 weeks–baseline ES=0.3 (0.1 to 0.6; p=0.15).
8 weeks–baseline ES=1.5 (0.3 to 2.6; p=0.01)
GAS, S.Cannot be calculated.4 weeks–baseline ES=13.3 (8.6 to 18.0; p=0.01).
8 weeks–baseline ES=17.9 (12.423.4; p=0.01)
QUEST, S.Cannot be calculated.4 weeks–baseline ES=3.9 (0.5 to 8.3; p=0.08)
8 weeks–baseline ES=4.6 (0.1 to 9.0; p=0.05)
CAPE, S.Cannot be calculated.No effect size.
During intervention period.ISelf-report minutes of OTHP participation per day (a calendar by parents).Both groups implemented the programme less than daily but 18 (4-week OTHP) or 17 (8-week OTHP) times per month. The mean session length was 15.66 min (range: 5–60 min) for the 4-week OTHP and 17.63 min (range: 4.28–40 min) for the 8-week OTHP. Most participants in the 4-week OTHP group did not discontinue the programme after 4 weeks, contrary to instruction, because parents reported that they perceived the programme as helpful and they considered it in the best interests of their child to continue. Only two participants in the 4-week OTHP group implemented the OTHP for 4 weeks as instructed.
Preston et al82 Computer-assisted arm rehabilitation gaming technology.Botulinum toxin treatment to reduce arm spasticity + usual follow-up rehabilitation.
Before randomisation and at 6 and 12 weeks.ABILHAND-Kids, P.6 weeks–baseline −0.48 (range −2.378 to −0.684) 12 weeks–baseline −0.61 (range −2.166 to 0.684)6 weeks–baseline −0.88 (range −2.341 to 0.611) 12 weeks–baseline −0.31 (range −2.341 to 1.42)6 weeks–baseline −0.51 (p=0.919)
12 weeks–baseline 0.19 (p=0.919)
Performance scale of COPM, S.Results only provided for all participants.6 weeks–baseline 0.9 (p=0.221)
12 weeks–baseline 0.1 (p=0.862)
During intervention period.IDiary describing the rehabilitation exercises performed daily.Mean number days the gaming technology was played on was 14 of the 40 days. Half of the children used the device for three or fewer of the 6 weeks, with one child using the gaming technology in the first week only. The mean total use per child was 99 min. The mean daily amount of time the gaming technology was played was 7 min, substantially less than the 30 min per day that was suggested to parents.
Sakzewski et al83 Goal-directed/functional training.Centre-based occupational therapy or physiotherapy intervention.
Pretest, at 13 weeks (post-test) and at 26 weeks (follow-up).MA, P.Post-test–pretest 0.3 (25.5)
Follow-up–pretest 0.1 (27.0)		Post-test–pretest −1.8 (26.0) Follow-up–pretest −0.8 (26.2)Post-test–pretest −2.3 (−5.6 to 1.0; p=0.2)
Follow-up–pretest −1.1 (−4.4 to 2.2; p=0.5)
AHA, P.Post-test–pretest 3.3 (25.6)
Follow-up–pretest 3.6 (27.6)		Post-test–pretest 1.6 (19.4)
Follow-up–pretest −0.6 (20.7)		Post-test–pretest −0.3 (−3.3 to 2.6; p=0.8)
Follow-up–pretest −3.1 (−6.0 to −0.2; p=0.04)
COPM, S.Post-test–pretest
Performance: 3.3 (2.5)
Satisfaction: 3.8 (2.0)
Follow-up–pretest Performance: 3.7 (2.1)
Satisfaction: 4.1 (1.7)		Post-test–pretest
Performance: 2.6 (1.9)
Satisfaction: 2.6 (2.4)
Follow-up–pretest Performance: 3.0 (1.9)
Satisfaction: 3.0 (2.1)		Post-test–pretest
Performance: −0.7 (−1.6 to 0.2; p=0.1)
Satisfaction: −1.2 (−2.2 to 0.1; p=0.04)
Follow-up–pretest Performance: −0.7 (−1.6 to 0.2; p=0.1)
Satisfaction: −1.0 (−2.1 to 0.0; p=0.06)
JTHFT, S.Post-test–pretest −29.7 (357.1) Follow-up–pretest −45.7 (358.2)Post-test–pretest −30.9 (348.7) Follow-up–pretest −56.3 (335.4)Post-test–pretest −5.0 (−49.9 to 40.0; p=0.8) Follow-up–pretest −14.4 (−59.4 to 30.5; p=0.5)
BBT, S.Post-test–pretest 3.3 (15.6)
Follow-up–pretest 3.8 (18.0)		Post-test–pretest 3.7 (16.5)
Follow-up–pretest 3.3 (16.1)		Post-test–pretest −0.7 (−3.8 to 2.4; p=0.6)
Follow-up–pretest 0.1 (−3.0 to 3.3; p=0.9)
CHEQ, S.Independent activities
Post-test–pretest 0.5 (6.9)
Follow-up–pretest 1.0 (6.7)		Independent activities
Post-test–pretest 0.9 (7.4)
Follow-up–pretest 0.7 (7.6)		Independent activities
Post-test–pretest 0.2 (−1.9 to 2.4; p=0.8)
Follow-up–pretest −0.5 (−2.8 to 1.8; p=0.7)
During intervention period.IDosage of therapy (home practice daily log for completion by parents).13 (68%) children in standard care completed home practice therapy logs, with an average of 20.9 hours (SD 10.7) of home practice completed over 12 weeks (range 4.5–39.8 hours).
Charles et al84 mCIMT.Care as usual.Control after treatment.
Pretest and post-test and at 1-month and 6-month follow-up.JTHFT, P.Post-test–pretest −82.7 (316.4)
1-month follow-up–pretest −92.6 (314.4)
6-month follow-up–pretest −88.7 (313.3)		Post-test–pretest −13.2 (254.4)
1-month follow-up–pretest −53.9 (234.3)
6-month follow-up–pretest −17.2 (267.4)		Post-test–pretest −0.6 (291.3)
1-month follow-up–pretest 5.0 (291.4)
6-month follow-up–pretest 18.2 (308.7)		Post-test–pretest
ES=0.315 (p<0.01)
Subtest 8 of BOTMP, S.Post-test–pretest 2.4 (4.2)
1-month follow-up–pretest 2.8 (5.3)
6-month follow-up–pretest 2.1 (4.8)		Post-test–pretest 0.4 (5.6)
1-month follow-up–pretest 0.7 (5.5)
6-month follow-up–pretest 1.5 (6.3)		Post-test–pretest 1.2 (7.9)
1-month follow-up–pretest 0.7 (7.8)
6-month follow-up–pretest 1.4 (8.2)		Post-test–pretest
ES=0.399 (p<0.005)
CFUS, S.How frequently
Post-test–pretest 0.4 (1.0)
1-month follow-up–pretest 0.7 (1.1)
6-month follow-up–pretest 0.7 (1.1)
How well
Post-test–pretest 0.5 (0.8)
1-month follow-up–pretest 1.0 (0.8)
6-month follow-up–pretest 0.9 (0.9)		How frequently
Post-test–pretest −0.3 (0.8)
1-month follow-up –pretest −0.1 (0.7)
6-month follow-up–pretest 0.0 (0.8)
How well
Post-test–pretest 0.2 (0.6)
1-month follow-up–pretest 0.1 (0.6)
6-month follow-up–pretest 0.1 (0.7)		How frequently
Post-test–pretest −0.1 (0.8)
1-month follow-up–pretest 0.2 (0.8)
6-month follow-up–pretest 0.1 (1.1)
How well
Post-test–pretest 0.1 (0.6)
1-month follow-up–pretest 0.2 (0.7)
6-month follow-up–pretest 0.3 (0.9)		How frequently
Post-test–pretest
ES=0.262 (p<0.001)
How well
Post-test–pretest
ES=0.285 (p<0.01)
TPD, S.Post-test–pretest −0.9 (4.8)
1-month follow-up–pretest −1.0 (4.5)
6-month follow-up–pretest 0.1 (5.1)		Post-test–pretest −1.3 (3.9)
1-month follow-up–pretest −1.1 (3.8)
6-month follow-up–pretest 0.0 (3.7)		Post-test– pretest −0.3 (3.3)
1-month follow-up–pretest 0.5 (4.4)
6-month follow-up–pretest −1.3 (2.6)		No effect size.
MAS, S.Shoulder
Post-test–pretest −0.4 (0.6)
1-month follow-up–pretest −0.1 (0.7)
6-month follow-up–pretest −0.3 (0.6)
Elbow
Post-test–pretest −0.2 (0.8)
1-month follow-up–pretest −0.1 (0.8)
6-month follow-up–pretest −0.2 (0.9)
Wrist
Post-test–pretest 0.0 (0.8)
1-month follow-up–pretest 0.1 (0.8)
6-month follow-up–pretest 0.0 (1.1)		Shoulder
Post-test–pretest 0.0 (1.0)
1-month follow-up–pretest −0.2 (0.9)
6-month follow-up–pretest −0.1 (1.0)
Elbow
Post-test–pretest −0.2 (1.3)
1-month follow-up–pretest −0.2 (1.3)
6-month follow-up–pretest 0.1 (1.2)
Wrist
Post-test–pretest 0.4 (1.3)
1-month follow-up–pretest 0.3 (1.1)
6-month follow-up–pretest 0.5 (1.2)		Shoulder
Post-test–pretest −0.6 (0.8)
1-month follow-up–pretest −0.4 (0.8)
6-month follow-up–pretest 0.0 (1.0)
Elbow
Post-test–pretest −0.3 (0.9)
1-month follow-up–pretest 0.0 (0.5)
6-month follow-up–pretest −0.1 (0.7)
Wrist
Post-test–pretest −0.3 (0.8)
1-month follow-up–pretest 0.2 (0.7)
6-month follow-up–pretest 0.4 (1.0)		No effect size.
During intervention period.IThe time each child practised at home during the intervention.The children used their involved upper extremity in home practice for an average of 5.7 hours per 10 days during the intervention and 7.3 hours per week for 6 months after the intervention.
Chamudot et al44 (CA), 97 mCIMT.Other home-based training programme.
Pretest and post-test.Mini-AHA, P.14.518.7No effect size.
FI, S.FI gross motor skills 0.3
FI unilateral hand use 0.6
FI bilateral hand use 0.5		FI gross motor skills 0.3
FI unilateral hand use 0.7
FI bilateral hand use 0.5		No effect size.
During intervention period.IThe infant’s compliance with the programme (recorded in a daily log by the parents).The average treatment time for the whole group was 46.7 hours (9.9) out of a total of 60 hours (78%). In the intervention group, the average was 48.4 hours (9.5; 81%); in the control group, it was 45.0 hours (10.2; 75%).
Ferre et al100 110 Bimanual training.Other home-based training programme.
Pretest, post-test and 6-month follow-up.BBT, P.Post-test–pretest 5.5
6-month follow-up–pretest 6.2		Post-test–pretest 1.3
6-month follow-up–pretest 3.8		No effect size.
AHA, P.Post-test–pretest 1.4
6-month follow-up–pretest −0.8		Post-test–pretest 0.2
6-month follow-up–pretest 3.0		No effect size.
COPM, S.COPM performance
Post-test–pretest 3.9
6-month follow-up–pretest 3.5
COPM satisfaction Post-test–pretest 3.5
6-month follow-up–pretest 2.9		COPM performance
Post-test–pretest 2.0
6-month follow-up–pretest 2.4
COPM satisfaction Post-test–pretest 2.6
6-month follow-up–pretest 3.1		No effect size.
During intervention period.IAdherence.Participants in the intervention and control groups completed on average 82.9 hours (12.7) and 76.7 hours (7.29) of home training.
IAdherence.On average, families performed seven activities per day, which lasted about 19 min per activity.
Fischer et al45 (CA) mCIMT.Other home-based training programme.Other home-based training programme.
Pretreatment and post-treatment, 6-month follow-up.PSS, S.Analysis of variance revealed no significant differences in PSS scores across therapy groups or between pretreatment and post-treatment.Not provided.
During intervention period.ASemistructured questionnaire.In the P-CIMT groups, 74% reported pretreatment stress concerning the use of a constraint, which declined to 44% post-treatment.
Additionally, 38% identified concerns related to therapy intensity before treatment, but only 3% reported that quantity of therapy received was too much, while 18% reported it was not enough.
Therapy occurring in the home was not a significant stressor pretreatment or post-treatment. At 6 months post-treatment, 42% of parents reported stress conducting the recommended home activities, with child behaviour and time constraints being contributing factors.
Hobbs et al46 (CA) Computer-based rehabilitation.Other home-based training programme.
On enrolment, immediately after the 6-week intervention and 4 weeks postintervention.JTHFT, S.Results not presented.Not provided.
On enrolment and immediately after the 6-week intervention.ABILHAND-Kids questionnaire.10 recorded increased logit scores (average increase 0.72 (0.63)).
4 recorded decreased logit scores (average decrease −1.10 (0.79)), with no change for 2 participants.		Not provided.
During intervention period.IAdherence.The average OrbIT system usage was 403 min (SD 322 min; range 117–1140 min) for the experimental group and 340 min (SD 134 min; range 136–526 min) for the control group. Overall, participants rated the system highly, scoring it 7.7 (SD 1.7) out of 10. Parents noted that the system increased sibling interaction and participation. From a utility perspective, the system was accessible, intuitive, robust and required minimal support.
Hughes et al103 NDT and ADL activities.Other home-based training programme.Control group.
Preassessment and postassessment.QUEST, S.Dissociated movements 11.91 (18.8)
Grasps 7.39 (13.0)
Weight-bearing 14.94 (25.0)
Protective extension 5.41 (29.7)
Total 11.9 (16.5)		Dissociated movements 8.78 (21.0)
Grasps 4.63 (15.29)
Weight-bearing 18.78 (28.7)
Protective extension −2.92 (26.62)
Total 7.09 (16.59)		Dissociated movements 9.15 (17.52)
Grasps 0.35 (23.4)
Weight-bearing 0.24 (25.8)
Protective extension −2.7 (31.7)
Total 1.7 (26.0)		Dissociated movements
ES=0.46 (p=0.53)
Grasps
ES=0.34 (0.43)
Weight-bearing
ES=1.22 (p=0.40)
Protective extension
0.45 (p=0.91)
Total ES=0.82 (p=0.96)
Postassessment.AQuestionnaire.Most caregivers (18 of 19) reported that the home programme was easy to follow. All the caregivers of the child participants who were evaluated for the final assessment felt that there was some improvement in their child over the duration of the study, also reporting improvement in upper limb functioning in the child’s ability to do everyday activities.
Kassee et al104 Virtual reality.Other home-based training programme.
Pre, post and 4-week follow-up.Melbourne Assessment of Unilateral Upper Limb Function-2 (Melbourne-2), S.Not on group level.Not provided.
ABILHAND-Kids questionnaire, S.Not on group level.Not provided.
Average maximal grip strength in the spastic and non-spastic hand, S.Not on group level.Not provided.
During intervention period.ICompliance using daily logs.All participants in the Wii training group demonstrated a higher compliance rate than the most compliant resistance participant.
AIn addition, the daily logs for both the Wii and resistance training groups asked the participants to directly respond each day to the following questions: (1) How much did you use your affected arm today? (2) How hard did you exercise today? (3) Did you have fun exercising today? The children were asked to respond to these questions on a 6-point Likert scale.Trend lines for both groups were variable, and the Wii training group had a greater response rate to the questions.
AParent feedback questionnaire (four questions) was used to assess motivation and feasibility of the intervention, as perceived by parents.Parents of participants in the Wii training group reported a more positive (higher) average response to all four questions asked. Parents of children in the Wii training group had a higher average positive response to all questions posed, regarding motivation and feasibility.
Law et al109 Intensive NDT and cast.Other home-based training programmes:
regular NDT plus cast; regular NDT.
After 6-month therapy and 3-month follow-up.Peabody Fine Motor Scales, S.Intensive NDT + cast
6 months–baseline 5.1 (19.2)
9 months–baseline 7.8 (18.0)
Intensive NDT
6 months–baseline 3.1 (25.4)
9 months–baseline 2.8 (25.7)		Regular NDT + cast
6 months–baseline 3.1 (27.3)
9 months–baseline 2.2 (27.0)
Regular NDT
6 months–baseline 3.5 (29.4)
9 months–baseline 5 (29.8)		Not provided.
QUEST, S.Intensive NDT+ cast
6 months–baseline 4.9 (31.8)
9 months–baseline 7.3 (28.0)
Intensive NDT
6 months–baseline 0.8 (37.6)
9 months–baseline 0.1 (37.3)		Regular NDT + cast
6 months–baseline 7.0 (36.3)
9 months–baseline 4.9 (37.1)
Regular NDT
6 months–baseline 1.4 (41.4)
9 months–baseline 1.5 (41.4)		Not provided.
Range of motion at the wrist, S.Results not presented.Not provided.
During intervention period.IAdherence.66% of the parents completed all or some of the home programme more than 75% of the time.
Liang et al48 (CA) mCIMT.Other home-based training programme.
Before and immediately after the intervention.Melbourne Assessment-2 (MA-2), S.Results not presented.Not provided.
BOT-2, S.Results not presented.Not provided.
BBT, S.Results not presented.Not provided.
PMAL-R.Results not presented.Not provided.
TOP, S.Results not presented.Not provided.
APSI-SF.Results not presented.
ASatisfactory Questionnaire.Caregivers of participants also showed high satisfaction towards the BIT programme.
Hobbs et al52 Computer-based rehabilitation.Other home-based training programme.
On enrolment, immediately after the intervention and 4 weeks postintervention.Tests of sensation (pressure sensitivity, texture discrimination, distal proprioception, and stereognosis), P.Results not presented.Not provided.
JTHFT, P.Results not presented.Not provided.
During intervention period.INot specified.OrbIT was rated highly by families (7.4±1.9 out of 10, median=8.0, n=17) and overall average system usage was 377±267 min.
Lowes et al80 mCIMT.Traditional occupational therapy services in an outpatient clinic.
At baseline and after each phase.BSID, S.Cognitive pre to post usual care occupational therapy 4.8 (2.8)
Pre to post CIMT 1 (1.4)
Pre to post follow-up 1.4 (1.7)
Fine motor score (more involved) Pre to post usual care occupational therapy 2.2 (1.8) Pre to post CIMT 4.2 (1.8)
Pre to post follow-up −0.8 (2.2)
Fine motor score (less involved)
Pre to post usual care occupational therapy 1.6 (1.7)
Pre to post CIMT 1.4 (1.9)
Pre to post follow-up 1.6 (1.5)
Gross motor score Pre to post usual care occupational therapy 1.0 (1.6) Pre to post CIMT 3.2 (1.9)
Pre to post follow-up 3.0 (1.9)		No effect size.
IMAL, S.Results not presented.No effect size.
During intervention period.IFidelity through a fidelity measure.89% consistent with the treatment protocol. The infants demonstrated engaged and on-task behaviour 74% of the time and were not engaged in the treatment activities 26% of the time.
IParent recordings of the amount of time spent involving the infant in targeted activities.All parents recorded that they performed the home programme for an hour or more each day. They reported that the individualised activities were easy to incorporate into their daily routine and naturally occurring opportunities. Parents’ comments and feedback regarding the programme were positive.

  • A, acceptability; ACC, accuracy; ADL, Activities of Daily Life; AHA, Assisting Hand Assessment; AMPS, Assessment of Motor and Process Skills; AO+RP, Action Observation + Repeated Practice; AOU, amount of hand use; BoNT-A, Botulinum Toxin A; BOT-2, Bruininks-Oseretsky Test of Motor Proficiency-2; BOT, Bimanual Occupational Therapy; BOTMP, Bruininks-Oseretsky Test of Motor Proficiency; BSID, Bayley Scales of Infant and Toddler Development-Third Edition; CA, conference abstract; CAPE, Children’s Assessment of Participation and Enjoyment; CFUS, Caregiver Functional Use Survey; CHEQ, Children’s Hand-use Experience Questionnaire; CIT, Constraint‐Induced Therapy; COPM, Canadian Occupational Performance Measure; DEX, dexterity ; EMD, estimated mean difference; ES, effect size; FI, Functional Inventory; FLU, fluency; GAS, Goal Attainment Scale; I, implementation; IMAL, Infant Motor Activity Log; JTHFT, Jebsen-Taylor Hand Function Test; MA-2, Melbourne Assessment of Unilateral Upper Limb Function 2; MA, Melbourne Assessment of Unilateral Upper Limb Function; MAS, Modified Ashworth Scale; mCIMT, modified Constraint-Induced Movement Therapy; mCIT, modified Constraint‐Induced Therapy; Mdn, median; Mini-AHA, Mini Assisting Hand Assessment; MMT, Manual Muscle Testing; NDT, neurodevelopmental treatment; OTHP, Occupational Therapy Home Program; PDMS-2, Peabody Developmental Motor Scales, Second Edition; PEDI, Pediatric Evaluation of Disability Inventory; PMAL, Pediatric Motor Activity Log; PMAL-R, Revised Pediatric Motor Activity Log; PSI-SF, Parenting Stress Index-Short Form; PSS, Perceived Stress Scale; QUEST, Quality of Upper Extremity Skills Test; QUO, quality of hand use; ROM, range of movement; TOP, Test of Playfulness; TPD, Two-Point Discrimination.