Fast track — ArticlesRetention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomised trial
Introduction
Constraint-induced movement therapy (CIMT) requires patients who have had a stroke to practise functionally relevant repetitive tasks, including shaping procedures, with the paretic limb for up to 6 h each weekday, and the less affected wrist and hand are restrained during most waking hours.1, 2 This form of CIMT differs from so-called forced use,3, 4 in which the patient must use the impaired limb during restraint of the better limb but without formal training, and from a distributed form of CIMT5 in which the patient wears a restraint for 5 h each weekday for 10 weeks and receives periodic rehabilitation sessions.
Use of CIMT within the first month after a stroke6 and during long-term poststroke disability1, 7, 8, 9, 10, 11, 12, 13 has been successful in patients who can initiate extension movements at the wrist and fingers before treatment.11, 14 The extremity constraint-induced movement therapy evaluation (EXCITE) trial15 showed that CIMT 3–9 months poststroke resulted in significant and clinically relevant improvements in upper limb function during the following year compared with those achieved with usual and customary care. Here, we assess retention of these effects and further improvements during the 24-month period after CIMT therapy in patients with subacute symptoms.
Section snippets
Participants
Methods used in the EXCITE trial have been published previously.16 At each of the seven study sites, potential participants were first screened by telephone (figure). Patients who had a disability caused by a first-time ischaemic or haemorrhagic stroke within the past 3–9 months received an on-site physical examination to establish whether they met higher functioning or lower functioning criteria.14, 17 Patients who could actively extend the wrist at least 20° and the metacarpophalangeal and
Results
The figure shows the trial profile. In this paper we report results from only the arm of the EXCITE trial in which patients received CIMT immediately after allocation. 22% of these patients had dropped out at 12 months and 34% at 24 months. These rates were 15% and 24% for 12 and 24 months, respectively, when dropout caused by death or deterioration of medical status was not included.
Table 1 shows least-square means at four time points, means for the whole post-CIMT period (post-CIMT through to
Discussion
Previous results from the EXCITE trial have shown that CIMT can produce statistically and clinically meaningful improvements in WMFT, MAL, and the SIS hand function domain after the intervention and 1 year later compared with those in participants who receive usual and customary care.15 When examined by functional level, concordance, or sex, the WMFT and MAL results did not change. Although the number of randomised clinical trials of stroke neurorehabilitation therapy is growing, so far none
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