EXCITE
Extremity Constraint-Induced Therapy
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Status:
Recruitment is complete with 94% (229) enrolled, 14 publications, and outcome papers in press. Results will be available later this year when they are published.
Purpose:
To determine whether constraint-induced movement therapy (CIMT) is as effective in subacute stroke patients (3 - 9 months poststroke) as it is in chronic stroke patients ( > 12 months post-stroke)
Interventions:
Constraint-induced therapy
Rehabilation approach: increased use of the affected extremity after stroke may promote recovery.
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Location(s):
Georgia, Alabama, California, Ohio, North Carolina, Florida
Year Started:
2001
Design:
Multi-center, randomized, blinded crossover study.
Inclusion Criteria
Patients presenting within 3 - 9 months of stroke (< 12 months) causing upper extremity impairment, and who have at least some ability to extend the disabled wrist and digits, will be eligible for this trial.
Patient Involvement:
Eligible patients will be randomized into subacute and chronic treatment groups. Upon randomization, the subacute group will receive CIMT, which involves constraining the functional arm during waking hours for two weeks, and training the disabled arm to perform basic activities for 6 hours every weekday during that period. The chronic treatment group will receive CIMT at 1 year post-randomization. Patients will be provided with standard medical and rehabilitative care throughout.
Primary Outcome:
The Wolf Motor Function Test (WMFT), a measure of laboratory time and strength-based ability and quality of movement (functional ability), and the Motor Activity Log (MAL), a measure of how well and how often 30 common daily activities are performed.
Secondary Outcome:
Changes in psychosocial functioning.
Results:
The CIMT group achieved significant improvements in hand/arm movement that lasted up to a year following treatment, with the CIMT group having a faster performance time of 19.3 seconds to 9.3 seconds [52% reduction] over the control group's time of 24.0 seconds to 17.7 seconds [26% reduction] on the WMFT. Also the CIMT group achieved an increase from 1.21 to 2.13 vs from 1.15 to 1.65 in the control group in the MAL Amount of Use, and increase from 1.26 to 2.23 vs 1.18 to 1.66 on the MAL Quality of Movement scale.
2 year follow-up results:
The effects at 24 months after treatment did not decline from those at 12 months for time taken to complete the WMFT (-0.32 s, 95% CI -3.70 to 3.06), for weight lifted in the WMFT (-1.39 kg, -2.74 to -0.04), for WMFT grip strength (-4.39 kg, -6.91 to -1.86), for amount of use in the MAL (-0.17, -0.38 to 0.04), or for how well the limb was used in the MAL (-0.14, -0.34 to 0.06). The additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT, p<0.0001. INTERPRETATION: Patients who have mild to moderate impairments 3-9 months poststroke have substantial improvement in functional use of the paretic upper limb and quality of life 2 years after a 2-week CIMT intervention. Thus, this intervention has persistent benefits.
Source of Information:
EXCITE web site.
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Web Links and Publications:
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This information last updated on: 1/28/2009
Reviewed on: 01/28/2009.
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