Effectiveness of Constraint-Induced Movement Therapy (CIMT) on Balance and Functional Mobility in the Stroke Population: A Systematic Review and Meta-Analysis

Jaya Shanker Tedla, Kumar Gular, Ravi Shankar Reddy, Arthur de Sá Ferreira, Erika Carvalho Rodrigues, Venkata Nagaraj Kakaraparthi, Giles Gyer, Devika Rani Sangadala, Mohammed Qasheesh, Rakesh Krishna Kovela, Gopal Nambi, Jaya Shanker Tedla, Kumar Gular, Ravi Shankar Reddy, Arthur de Sá Ferreira, Erika Carvalho Rodrigues, Venkata Nagaraj Kakaraparthi, Giles Gyer, Devika Rani Sangadala, Mohammed Qasheesh, Rakesh Krishna Kovela, Gopal Nambi

Abstract

Constraint-induced movement therapy (CIMT) is one of the most popular treatments for enhancing upper and lower extremity motor activities and participation in patients following a stroke. However, the effect of CIMT on balance is unclear and needs further clarification. The aim of this research was to estimate the effect of CIMT on balance and functional mobility in patients after stroke. After reviewing 161 studies from search engines including Google Scholar, EBSCO, PubMed, PEDro, Science Direct, Scopus, and Web of Science, we included eight randomized controlled trials (RCT) in this study. The methodological quality of the included RCTs was verified using PEDro scoring. This systematic review showed positive effects of CIMT on balance in three studies and similar effects in five studies when compared to the control interventions such as neuro developmental treatment, modified forced-use therapy and conventional physical therapy. Furthermore, a meta-analysis indicated a statistically significant effect size by a standardized mean difference of 0.51 (P = 0.01), showing that the groups who received CIMT had improved more than the control groups. However, the meta-analysis results for functional mobility were statistically insignificant, with an effect size of -4.18 (P = 0.16), indicating that the functional mobility improvements in the investigated groups were not greater than the control group. This study's findings demonstrated the superior effects of CIMT on balance; however, the effect size analysis of functional mobility was statistically insignificant. These findings indicate that CIMT interventions can improve balance-related motor function better than neuro developmental treatment, modified forced-use therapy and conventional physical therapy in patients after a stroke.

Keywords: balance; constraint-induced movement therapy; functional mobility; stroke.

Conflict of interest statement

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 1
Figure 1
Flowchart showing the process of data collection and analysis.
Figure 2
Figure 2
Risk of bias assessment of the included studies.
Figure 3
Figure 3
Meta-analysis results on the effect of CIMT on balance among stroke population.
Figure 4
Figure 4
Meta-analysis results on the effect of CIMT on functional mobility among stroke population.

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