The effectiveness of modified constraint-induced movement therapy on upper limb function in children with cerebral...

Modified constraint-induced movement therapy (m-CIMT) has been increasingly employed in the rehabilitation of upper limb function in children with cerebral palsy (CP). However, its effectiveness remains inconclusive. This study aimed to evaluate the therapeutic impact of m-CIMT on upper limb function in children with CP.

A systematic search was performed across six electronic databases-China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, Web of Science, the Cochrane Library, and Embase-from their inception to May 6, 2025. Only randomized controlled trials (RCTs) examining the effects of m-CIMT on upper limb function in children with CP were included. All outcomes related to upper limb function-regardless of the specific measurement tools used-were treated as indicators of the same functional improvement goal, and modeled using a three-level meta-analytic approach, which accounts for sampling variance, within-study variance, and between-study variance. The study design was specified in this section to avoid redundancy in the objective. The Cochrane Risk of Bias 2.0 (RoB 2.0) tool was used to assess methodological quality, and the GRADE approach was employed to evaluate the certainty of the evidence. Data synthesis was conducted using the metafor package in R, generating forest plots, funnel plots, and conducting sensitivity analyses, subgroup analyses, and Egger's test for publication bias.

A total of ten studies met the inclusion criteria. The overall risk of bias was low for most outcomes, with eleven outcomes rated as low risk across all assessed domains. A few outcomes were rated as having some concerns or high risk, primarily due to unblinded subjective outcome reporting. The meta-analysis indicated that m-CIMT may have a positive effect on upper limb function in children with CP (g = 0.58, 95% CI [0.02, 1.14], P = 0.043; 95% PI [- 1.17, 2.33]). However, evidence of publication bias was detected (t = 5.58, P < 0.001), and the overall quality of evidence was rated as very low. Subgroup analysis revealed that the "type of constraint used" significantly moderated the intervention effect (F(2, 51) = 3.69, P = 0.032).

Based on the current evidence, m-CIMT may improve upper limb function in children with CP, but due to the very low certainty of evidence and potential publication bias, these findings should be interpreted with caution. Further high-quality randomized controlled trials with standardized protocols and longer follow-up are needed. Future research should also focus on individualized treatment approaches to support the implementation of m-CIMT as an evidence-based precision rehabilitation strategy.