Stroke patients with mild to moderate impairments have substantial improvement in upper limb function and quality of life 2 years after receiving just 2 weeks of constraint-induced movement therapy* (CIMT), according to an Article to be published early Online and in the January issue of The Lancet Neurology. This has important implications for upper extremity stroke rehabilitation.
This study is a continuation of the EXCITE trial** that showed how a 2-week CIMT intervention provided better outcomes in hand function after 12 months compared to those who were randomly assigned to usual and customary care. Although the number of stroke rehabilitation therapy trials is growing, so far none has reported the retention of improvements past 1 year.
Professor Steven Wolf (Emory University School of Medicine, Atlanta, USA) and colleagues assessed whether the retention improvements in the EXCITE trial were retained 24 months after the 2-week CIMT intervention. The researchers found that the effects at 24 months after treatment did not decline from those at 12 months. Moreover, strength showed continued improvement during the second year. Further, they found quality of life was significantly improved 2 years after the intervention--this included improvements in social participation, activities of daily living, and overall physical function. The authors suggest that higher functioning patients may have benefited more from CIMT than lower functioning patients because the largest long-term changes were recorded in the higher functioning group.
The authors say: "For a number of stroke survivors with mild to moderate stroke--perhaps up to 30% of stroke survivors--CIMT can be implemented successfully with long-lasting functional outcomes."***
They conclude: "These results emphasise the importance of long-term follow-up in rehabilitation clinical trials, to show the full extent of effects of therapeutic interventions."
The paper associated with this release can be found at http://www.eurekalert.org/jrnls/lance/TLNlimbfunction.pdf
Notes to Editors
* The aim of CIMT is to promote the use of a limb that is functionally impaired after a stroke. CIMT requires patients to practise functionally relevant repetitive tasks with the impaired limb, while the less severely affected arm is restrained during most waking hours.
**The extremity constraint-induced movement therapy evaluation (EXCITE) trial. JAMA 2996; 296: 2095–104
***Quote directly from author and cannot be found in text of article.
Journal
The Lancet Neurology