Table 5

Results of the effectiveness 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))
Facchin et al95mCIMT.Other home-based training programme.Care as usual.
Before and after the 10-week treatment.QUEST, P.QUEST
Global score 7.2
Grasp 7.1
Dissociated movements 6.1
Protective extension 8.6
Weight-bearing 6.6
QUEST-affected limb
Global score 8.2
Grasp 2.0
Dissociated movements 2.3
Protective extension 2.3
Weight-bearing 1.6
QUEST-non-affected limb
Global score 0.9
Grasp −0.3
Dissociated movements 0.7
Protective extension 0.0
Weight-bearing 0.6		QUEST
Global score 4.4
Grasp 3.6
Dissociated movements 3.1
Protective extension 2.3
Weight-bearing 8.9
QUEST-affected limb
Global score 6.3
Grasp 0.7
Dissociated movements 0.8
Protective extension 2.3
Weight-bearing 2.3
QUEST-non-affected limb
Global score 3.5
Grasp 0.5
Dissociated movements 0.7
Protective extension 1.0
Weight-bearing 1.3		QUEST
Global score 1.3
Grasp 2.5
Dissociated movements 2.7
Protective extension −1.5 
Weight-bearing 2.6
QUEST-affected limb
Global score 3.1
Grasp −0.1
Dissociated movements 1.6
Protective extension 1.9
Weight-bearing −0.3
QUEST-non-affected limb
Global score 2.0
Grasp −0.3
Dissociated movements 0.9
Protective extension −0.2
Weight-bearing 1.1		No effect size.
Besta Scale, P.Global score 0.23
Grasp 0.28
Bimanual spontaneous use 0.25
ADL (2–6 years) 0.21
ADL (7–8 years) −0.21		Global score 0.23
Grasp 0.08
Bimanual spontaneous use 0.29
ADL (2–6 years) 0.21
ADL (7–8 years) 0.0		Global score 0.06
Grasp 0.06
Bimanual spontaneous use 0.14
ADL (2–6 years) 0.05
ADL (7–8 years) 0.34		No effect size.
Chen et al87mCIMT.Other home-based training programme.
Baseline, 4 weeks (post-test), and 3-month and 6-month follow-up.Subtest 8 of BOTMP, P.Post-test–baseline 3.96 (2.6)
3 months–baseline 5.96 (2.5)
6 months–baseline 6.87 (2.5)		Post-test–baseline 3.22 (2.0)
3 months–baseline 4.63 (2.0)
6 months–baseline 5.5 (1.8)		Post-test–baseline ES=0.058 (p=0.116)
3 months–baseline ES=0.167 (p=0.006)
6-months–baseline ES=0.193 (p=0.003)
Fine motor domain of PDMS-2, P.Post-test–baseline 4.31 (4.0)
3 months–baseline 6.93 (4.0)
6 months–baseline 8.13 (4.1)		Post-test–baseline 2.54 (4.2)
3 months–baseline 3.86 (4.2)
6 months–baseline 4.82 (4.3)		Post-test–baseline ES=0.604 (p<0.001)
3 months–baseline ES=0.634 (p<0.001)
6 months–baseline ES=0.658 (p<0.001)
WeeFIM, S.Post-test–baseline 3.04 (8.9)
3 months–baseline 5.21 (8.5)
6 months–baseline 7.26 (8.2)		Post-test–baseline 2.32 (5.2)
3 months–baseline 4.36 (5.1)
6 months–baseline 6.00 (5.0)		Post-test–baseline ES=0.195 (p=0.003)
3 months–baseline ES=0.202 (p=0.002)
6 months–baseline ES=0.264 (p<0.001)
Reach-to-grasp task (kinematic analysis), S.Post-test–baseline
RT (s) −0.07 (0.02)
nMT (s/mm) −0.06 (0.07)
nMU (times/mm) −0.03 (0.04)
PV (mm/s) 0.74 (6.34)
MGA (cm) −1.49 (1.27)
PMGA (%) 11.36 (20.52)
3 months–baseline
RT (s) −0.11 (0.03)
nMT (s/mm) −0.12 (0.06) nMU (times/mm) −0.05 (0.05)
PV (mm/s) 4.66 (6.42)
MGA (cm) −1.58 (1.34)
PMGA (%) 10.44 (24.54)
6 months–baseline
RT (s) −0.14 (0.03)
nMT (s/mm) −0.15 (0.06) nMU (times/mm) −0.07 (0.05)
PV (mm/s) 6.14 (6.39)
MGA (cm) −0.94 (1.44)
PMGA (%) 4.9 (22.73)		Post-test–baseline
RT (s) −0.04 (0.02)
nMT (s/mm) −0.04 (0.04)
nMU (times/mm) −0.03 (0.05)
PV (mm/s) 2.34 (4.38)
MGA (cm) −0.73 (1.29)
PMGA (%) −5.28 (20.83)
3 months–baseline
RT (s) −0.08 (0.03)
nMT (s/mm) −0.07 (0.04)
nMU (times/mm) −0.03 (0.04)
PV (mm/s) 4.40 (4.00)
MGA (cm) −0.99 (1.39)
PMGA (%) −11.44 (19.93)
6 months–baseline
RT (s) −0.11 (0.04)
nMT (s/mm) −0.10 (0.04)
nMU (times/mm) −0.05 (0.04)
PV (mm/s) 5.80 (3.70)
MGA (cm) −0.77 (1.29)
PMGA (%) −6.72 (16.83)		Post-test–baseline
RT (s) ES=0.133 (p=0.015)
nMT (s/mm) ES=0.158 (p=008)
nMU (times/mm) ES=0.027 (p=0.291)
PV (mm/s) ES=0.004 (p=0.670)
MGA (cm) ES=0.165 (p=0.006)
PMGA (%) ES=0.055 (p=0.125)
3 months–baseline
RT (s) ES=0.221 (p=0.001)
nMT (s/mm) ES=0.494 (p<0.001)
nMU (times/mm) ES=0.137 (p=0.049)
PV (mm/s) ES=0.006 (p=0.608)
MGA (cm) ES=0.084 (p=0.057)
PMGA (%) ES=0.013 (p=0.454)
6 months–baseline
RT (s) ES=0.137 (p=0.014)
nMT (s/mm) ES=0.601 (p<0.001)
nMU (times/mm) ES=0.136 (p=0.014)
PV (mm/s) ES=0.013 (p=0.463)
MGA (cm) ES=0.008 (p=0.564)
PMGA (%) ES=0.005 (p=0.659)
Chiu et al34 (CA), 88Virtual reality.Care as usual.
At baseline, at 6 weeks (after intervention) and at 12 weeks (6 weeks beyond the intervention).Tracking task (elbow and index finger), S.Week 6–baseline
Elbow 0.03 (0.13)
Finger 0.01 (0.07)
Week 12–baseline
Elbow 0.01 (0.14)
Finger 0.02 (0.11)		Week 6–baseline
Elbow −0.01 (0.13)
Finger 0.02 (0.14)
Week 12–baseline
Elbow −0.04 (0.12)
Finger 0.02 (0.11)		Week 6–baseline
Elbow 0.04 (−0.03 to 0.11)
Finger −0.01 (−0.07 to 0.05)
Week 12–baseline
Elbow 0.05 (−0.02 to 0.12)
Finger 0.00 (−0.06 to 0.06)
Power grip by PowerTrack IITM commander, S.Week 6–baseline 4.9 (10.7)
Week 12–baseline 7.1 (13.1)		Week 6–baseline 0.9 (7.5)
Week 12–baseline 3.0 (9.5)		Week 6–baseline 4.0 (−0.8 to 8.8)
Week 12–baseline 4.1 (−2.1 to 10.3)
Nine-Hole Peg Test, S.Week 6–baseline 0.0 (0.02)
Week 12–baseline 0.01 (0.11)		Week 6–baseline 0.01 (0.03)
Week 12–baseline 0.01 (0.03)		Week 6–baseline −0.01 (−0.02 to 0.00)
Week 12–baseline 0.00 (−0.04 to 0.04)
JTHFT, S.Week 6–baseline 0.05 (0.06)
Week 12–baseline 0.09 (0.07)		Week 6–baseline 0.05 (0.06)
Week 12–baseline 0.10 (0.07)		Week 6–baseline 0.00 (−0.03 to 0.03)
Week 12–baseline −0.01 (−0.05 to 0.03)
CFUS, S.Week 6–baseline
Quantity 4.6 (9.9)
Quality 3.9 (9.4)
Week 12–baseline
Quantity 8.1 (9.7)
Quality 5.2 (10.3)		Week 6–baseline
Quantity 0.1 (10.2)
Quality 0.7 (7.8)
Week 12–baseline
Quantity 1.7 (12.3)
Quality 1.7 (11.7)		Week 6–baseline
Quantity 4.5 (−0.7 to 9.7)
Quality 3.2 (−1.3 to 7.7)
Week 12–baseline
Quantity 6.4 (0.5 to 12.3)
Quality 3.5 (−2.3 to 9.3)
Kim et al90Strength training.Centre-based occupational therapy or physiotherapy intervention.
Before and after the intervention (10 weeks).Motion analysis: the left and right upper limbs were reached out five times with a convenient speed and fast speed, S.Movement time (s)
Comfortable speed: −0.4 (1.0)
Fast speed: −0.1 (0.4)
Mean velocity (cm/s)
Comfortable speed: 7.4 (8.2)
Fast speed: 14.1 (18.4)
Normalised jerk score
Comfortable speed: −11.8 (93.0)
Fast speed: −53.2 (166.3)
Shoulder mean angular velocity (cm/s)
Comfortable speed: 18.0 (34.0)
Fast speed: 17.8 (38.3)
Elbow mean angular velocity (cm/s)
Comfortable speed: 13.3 (36.9)
Fast speed: 14.2 (38.0)
Wrist mean angular velocity (cm/s)
Comfortable speed: 5.1 (15.1)
Fast speed: 14.6 (38.5)
Shoulder normalised jerk score
Comfortable speed: −50.8 (194.5)
Fast speed: 16.0 (128.3)
Elbow normalised jerk score
Comfortable speed: −136.4 (596.9)
Fast speed: −11.5 (375.8)
Wrist normalised jerk score
Comfortable speed: −552.3 (880.1)
Fast speed: −206.8 (266.1)		Movement time (s)
Comfortable speed: −1.1 (1.5)
Fast speed: −0.6 (0.9)
Mean velocity (cm/s)
Comfortable speed: 21.5 (23.0)
Fast speed: 33.1 (31.9)
Normalised jerk score
Comfortable speed: −168.3 (199.4)
Fast speed: −199.4 (260.2)
Shoulder mean angular velocity (cm/s)
Comfortable speed: 42.7 (55.9)
Fast speed: 64.5 (71.1)
Elbow mean angular velocity (cm/s)
Comfortable speed: 22.7 (24.8)
Fast speed: 32.7 (31.9)
Wrist mean angular velocity (cm/s)
Comfortable speed: 21.8 (15.8)
Fast speed: 38.8 (38.9)
Shoulder normalised jerk score
Comfortable speed: −107.3 (281.4)
Fast speed: −127.8 (256.3)
Elbow normalised jerk score
Comfortable speed: −451.3 (472.3)
Fast speed: −669.8 (994.6)
Wrist normalised jerk score
Comfortable speed: −633.3 (592.9)
Fast speed: −630.0 (670.4)		No effect size.
Xu et al92Constraint therapy and electrical stimulation.Other home-based training programme.Other home-based training programme.
At 2 weeks immediately after the hospital-based intervention, and at 3 and 6 months after the start of the home-based intervention.Sphygmomanometry, S.Results not described.No effect size.
Upper extremity functional test, S.Results not described.No effect size.
Global rating scale, S.Results not described.No effect size.
Surface EMG (Flexcomp Infiniti surface EMG analysis system), S.RMS of involved wrist extensors
Week 2–baseline 12.8 (17.8)
Month 3–baseline 21.9 (18.9)
Month 6–baseline 31.3 (21.8)
RMS of involved wrist flexors
Week 2–baseline 6.7 (13.8)
Month 3–baseline 17.3 (17.2)
Month 6–baseline 27.1 (25.0)
RMS of uninvolved wrist extensors
Week 2–baseline −4.0 (9.0)
Month 3–baseline −5.0 (9.5)
Month 6–baseline −8.8 (8.6)
RMS of uninvolved wrist flexors
Week 2–baseline −3.8 (7.8)
Month 3–baseline −5.6 (8.8)
Month 6–baseline −8.4 (9.5)
iEMG of involved wrist extensors
Week 2–baseline 282.7 (335.3)
Month 3–baseline 444.7 (392.6)
Month 6–baseline 636.1 (416.1)
iEMG of involved wrist flexors
Week 2–baseline 200.6 (254.1)
Month 3–baseline 308.5 (321.7)
Month 6–baseline 428.4 (360.1)
Cocontraction ratio
Week 2–baseline −2.7 (4.2)
Month 3–baseline −3.7 (4.6)
Month 6–baseline −5.0 (5.4)
iEMG of uninvolved wrist extensors
Week 2–baseline 3.7 (62.2)
Month 3–baseline −28.3 (92.5)
Month 6–baseline −59.3 (92.3)
iEMG of uninvolved wrist flexors
Week 2–baseline 4.6 (36.4)
Month 3–baseline −27.3 (77.4)
Month 6–baseline −53.3 (106.0)		RMS of involved wrist extensors
Week 2–baseline 9.1 (9.7)
Month 3–baseline 16.8 (11.3)
Month 6–baseline 24.9 (14.6)
RMS of involved wrist flexors
Week 2–baseline 6.6 (8.0)
Month 3–baseline 15.1 (9.4)
Month 6–baseline 24.2 (14.3)
RMS of uninvolved wrist extensors
Week 2–baseline −4.0 (4.0)
Month 3–baseline −4.4 (4.0)
Month 6–baseline −6.5 (5.3)
RMS of uninvolved wrist flexors
Week 2–baseline −3.9 (4.9)
Month 3–baseline −4.6 (4.6)
Month 6–baseline −6.9 (5.8)
iEMG of involved wrist extensors
Week 2–baseline 159.9 (180.7)
Month 3–baseline 244.4 (199.9)
Month 6–baseline 321.9 (256.1)
iEMG of involved wrist flexors
Week 2–baseline 155.0 (187.1)
Month 3–baseline 232.7 (211.2)
Month 6–baseline 301.7 (263.9)
Cocontraction ratio
Week 2–baseline −0.6 (1.2)
Month 3–baseline −0.9 (1.2)
Month 6–baseline −1.2 (1.3)
iEMG of uninvolved wrist extensors
Week 2–baseline 5.2 (28.9)
Month 3–baseline −25.4 (42.9)
Month 6–baseline −54.4 (56.5)
iEMG of uninvolved wrist flexors
Week 2–baseline 3.2 (26.5)
Month 3–baseline −24.7 (43.0)
Month 6–baseline −55.2 (52.6)		Results not described.No effect size.
Abd El-Kafy et al93mCIMT.Other home-based training programme.
Pretreatment, immediately post-treatment (post 1: 4 weeks after the start of the intervention) and 3 months post-treatment (post 2).PAFT, S.Mean rank (n=14)
Unilateral functional activities
Post 1–baseline 1.21
Post 2–baseline 1.21
Bilateral functional activities
Post 1–baseline 0.97
Post 2–baseline 0.33		Mean rank (n=13)
Unilateral functional activities
Post 1–baseline −1.31
Post 2–baseline −1.31
Bilateral functional activities
Post 1–baseline −1.04
Post 2–baseline −0.35		No effect size.
QUEST, S.Mean rank (n=14)
Post 1–baseline 6.14
Post 2–baseline 6.07		Mean rank (n=13)
Post 1–baseline 3.38
Post 2–baseline 3.46		No effect size.
Isokinetic muscular performances of the shoulder flexors, extensors and abductor muscles, S.Shoulder flexor muscles
Post 1–baseline 2.18 (2.6)
Post 2–baseline 1.08 (2.3)
Shoulder extensor muscles
Post 1–baseline 2.32 (2.1)
Post 2–baseline 1.93 (1.7)
Shoulder abductor muscles
Post 1–baseline 2.60 (2.0)
Post 2–baseline 1.32 (2.0)		Shoulder flexor muscles
Post 1–baseline 0.43 (2.1)
Post 2–baseline 0.32 (1.7)
Shoulder extensor muscles
Post 1–baseline 0.26 (1.5)
Post 2–baseline 0.18 (1.5)
Shoulder abductor muscles
Post 1–baseline 0.66 (2.2)
Post 2–baseline 0.46 (2.1)		No effect size.
Bagley et al35 (CA)Home therapy programme.Surgical intervention.Drug intervention.
At entry into the study, at 6 months and at 12 months.AHA, S.12 months–baseline 2.5 (6.6)12 months–baseline 1.2 (12.2)12 months–baseline 1.6 (14.5)No effect size.
SHUEE, DPA and SFA.SFA 12 months–baseline 3.8 (22.5)
DPA 12 months–baseline −1.5 (19.9)		SFA 12 months–baseline 4.5 (26.7)
DPA 12 months–baseline 21.2 (14.5)		SFA 12 months–baseline 4.3 (29.5)
DPA 12 months–baseline 2.4 (20.0)		No effect size.
Box and Blocks Test.12 months–baseline 1.3 (12.3)12 months–baseline 1.0 (10.0)12 months–baseline −1.0 (12.6)No effect size.
Pinch and grip strength, S.Results not described.No effect size.
Pediatric Outcomes Data Collection Instrument, S.Results not described.No effect size.
COPM, S.Results not described.No effect size.
CAPE, S.Results not described.No effect size.
Hoare et al36 37 (CA)mCIMT.Other home-based training programme.
At baseline, 1, 3 and 6 months.AHA, P.Results not described.1 month–baseline 0.62 (−1.47 to 0.22; p=0.14).
6 months–baseline 0.58 (−1.43 to 0.28; p=0.19)
QUEST, S.Results not described.Dissociated movement ES=0.08 (p=0.47)
Grasp domain ES=0.10 (p=0.38)
PEDI, S.Results not described.Self-care functional skills ES=0.07 (p=0.51)
Self-care caregiver assistance ES=0.02 (p=0.87)
COPM, S.Results not described.COPM performance ES=0.03 (p=0.80)
COPM satisfaction ES=0.03 (p=0.80)
GAS.Results not described.Not provided.
Klingels et al38 (CA)mCIMT.Other home-based training programme.
At baseline, after intervention and at 10 weeks follow-up.AHA, P.Results not described.No effect size.
Muscle tone, S.Results not described.No effect size.
Strength, S.Results not described.No effect size.
Melbourne Assessment, S.Results not described.No effect size.
JTHFT, S.Results not described.No effect size.
ABILHAND-Kids, S.Results not described.No effect size.
Koseotlu et al39 (CA)mCIMT and bimanual training.mCIMT.
ns.Unimanual capacity, P.Results not described.No effect size.
Bimanual performance, P.Results not described.No effect size.
Movement efficiency and speed of the affected hand, S.Results not described.No effect size.
Active range of motion of the wrist and forearm, S.Results not described.No effect size.
Level of independence in activities of daily living, S.Results not described.No effect size.
Novak et al40 41 (CA)Home programme intervention.Other home-based training programme.Control group.
Baseline, at 4 weeks and at 8 weeks.COPM, P.Results not described.4 weeks–baseline
ES=2.4 (0.7 to 4.2)
8 weeks–baseline
ES=1.4 (0.6 to 2.2)
GAS, S.Results not described.Not provided.
QUEST, S.Results not described.Not provided.
CAPE, S.Results not described.Not provided.
Sakzewski et al42 43 (CA)Distributed standard individualised therapy.Centre-based occupational therapy or physiotherapy intervention.
Baseline, at 13 weeks and at 26 weeks.Melbourne Assessment of Unilateral Upper Limb Function, S.Results not described.Not provided.
JTHFT, S.Results not described.Not provided.
AHA, S.Results not described.Not provided.
COPM, S.Results not described.COPM performance
26 weeks–baseline EMD=4.7 (0.9 to 8.5; p=0.02)
COPM satisfaction
13 weeks–baseline EMD=1.2 (0.01 to 2.3; p=0.03)
Crocker et al89Forced use therapy.Care as usual.
Three times during the presplinting and postsplinting phases, five times during the splinting phase, and once at the 6-month follow-up.Videotaping, S.Total frequency of use of the subject’s right upper extremity for the behaviours recorded during the videotaped sessions averaged 20 observations between observers in the presplinting phase. In the splinting phase, the frequency increased by more than twofold to a mean of 48 observations per session, followed by a reduction during the postsplinting phase to a mean of 38 observations per session. At 6-month follow-up, a mean of 50 observations were recorded by two observers.Not provided.
Once during each phase.Fine motor domain of PDMS-2, S.The total score increased by 9 points from the presplinting to the splinting phase, increased by 17 points from the splinting to postsplinting phase, and decreased at 6-month follow-up to a score similar to that obtained in the splinting phase.Not provided.
During intervention period.Daily log by the parents, S.The subject did not use her more-involved extremity to bring finger foods to her mouth during the daily feeding task at any time during the study.Not provided.
During intervention period.Qualitative observations by the parents, S.The mother’s observations corroborated the findings.Not provided.
Naylor and Bower91mCIMT.No therapy.
At baseline, 4 weeks (start of experimental intervention), 8 weeks (end of experimental intervention), 12 weeks (follow-up).QUEST, P.Baseline observation period (A) (difference after and before)
1.226 (1.382) (95% CI 2.288 to 0.164)
Treatment period (B) (difference after and before)
10.907 (4.649) (95% CI 14.480 to 7.333)
Follow-up period (A) (difference after and before)
1.188 (1.246) (95% CI 2.146 to 0.230)		No effect size.
Coker et al94mCIMT.Other home-based training programme.
Initial evaluation, at the end of first baseline phase A (A1), the end of the first intervention phase B (B1), the end of the second baseline phase A (A2), the end of the second intervention phase B (B2), and at 6-month follow-up.PDMS-2, S.The child in this study improved his gross and fine motor movement patterns after participation in mCIMT and demonstrated motor skills average for his chronological age despite motor deficits resulting from a right-sided hemiparesis. These new motor movements were maintained during non-intervention phases of this study and after a 6-month follow-up evaluation when he was not receiving mCIMT. The child showed greater motor progress during mCIMT periods than when participating in traditional weekly therapy sessions. This was especially evident during the first mCIMT intervention phase (B1).Not provided.
GMFM-88, S.Not provided.
Repeated measures during phases A1, B1, A2 and B2.Videotaping of unstructured play, S.Not provided.
Gross et al96Target joint movements.Centre-based occupational therapy or physiotherapy intervention.
Baseline phase: 1–6 measurements; training phase: 1–6 measurements; follow-up: 1 measurement.Target joint movements measured from videotapes using a goniometer, P.Arm extension was stable during the baseline and follow-up phase, and a large increase was seen during the training period.Not provided.

  • ADL, Activities of Daily Life; AHA, Assisting Hand Assessment; BOTMP, Bruininks-Oseretsky Test of Motor Proficiency; CA, conference abstract; CAPE, Children’s Assessment of Participation and Enjoyment; CFUS, Caregiver Functional Use Survey; COPM, Canadian Occupational Performance Measure; DPA, dynamic positional analysis; EMD, estimated mean difference; EMG, electromyography; ES, effect size; GAS, Goal Attainment Scale; GMFM-88, Gross Motor Function Measure-88; JTHFT, Jebsen-Taylor Hand Function Test; mCIMT, modified Constraint-Induced Movement Therapy; MGA, Maximum Grip Aperture; nMT, normalized Movement Time; nMU, normalized Movement Unit; ns, not specified; PAFT, Pediatric Arm Function Test; PDMS-2, Peabody Developmental Motor Scales, Second Edition; PEDI, Pediatric Evaluation of Disability Inventory; PMGA, percent time where MGA occurs; PV, Peak Velocity; QUEST, Quality of Upper Extremity Skills Test; RMS, Root Mean Square; RT, Reaction Time; SFA, spontaneous functional analysis; SHUEE, Shriners Hospital for Children Upper Extremity Evaluation; WeeFIM, Functional Independence Measure.