A Cochrane review included 42 studies with a total of 1453 patients with stroke. A total of 56% of patients had an ischaemic stroke, 44% had a haemorrhagic stroke.The time from stroke to constraint-induced movement therapy (CIMT) varied from 0 months to 10 years. The trials included participants who had some residual motor power of the paretic arm, the potential for further motor recovery and with limited pain or spasticity, but tended to use the limb little, if at all. The follow-up time was 3 years for one trial, for the rest of the trials it was 0 - 12 months. Eleven trials (n=344) assessed disability immediately after the intervention, indicating a non-significant SMD of 0.24 (95% CI -0.05 to 0.52) favouring CIMT compared with conventional treatment. For the most frequently reported outcome, arm motor function (28 studies, n= 858), the SMD was 0.34 (95% CI 0.12 to 0.55) showing a significant effect (P = 0.004) in favour of CIMT. Three studies (n=125) explored disability after a few months of follow-up and found no significant difference, SMD -0.20 (95% CI -0.57 to 0.16) in favour of conventional treatment.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), imprecise results (few patients in each trial), inconsistency (heterogeneity in patients, interventions and outcomes) and indirectness (short follow-up times).