Systematic Review and Meta-analysis of the Efficacy of Shorter Duration Modified Constraint-Induced Movement Therapy
Pavlina Psychouli1, Charalambos Anastasiou1, Ioannis Mamais1
1Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus.
Objective:
To evaluate the efficacy of a specific group of modified constraint-induced movement therapy (mCIMT) protocols, including ≤39 hours of therapist-supervised training combined with ≥10 h/d of restraint, on upper limb motor function in adults with chronic stroke.
Data Sources:
PubMed, Scopus, EBSCO, and the Cochrane Library were systematically searched up to March 20, 2025, using MeSH terms related to stroke, constraint-induced therapy, and upper limb function.
Study Selection:
Randomized controlled trials (RCTs) involving adults with chronic stroke who received mCIMT compared with conventional rehabilitation were included. Exclusion criteria included multimodal interventions or insufficient outcome data. Of 6486 records, 5 RCTs (n=239) met the inclusion criteria.
Data Extraction:
Two reviewers independently extracted study and participant characteristics, intervention details, and upper limb outcomes. Risk of bias was assessed with the Cochrane Risk of Bias Tool for Randomized Trials-2, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Data Synthesis:
Meta-analysis revealed significant larger improvements for the intervention group compared with controls posttreatment: Wolf Motor Function Test Functional Ability (mean difference [MD]=0.59; 95% CI, 0.23-0.94), Motor Activity Log Quality of Movement (MD=1.08; 95% CI, 0.61-1.55), and Amount of Use (MD=1.01; 95% CI, 0.24-1.79). Wolf Motor Function Test Performance Time improved modestly (standardized mean difference=-0.36; 95% CI: -0.68 to -0.04). At follow-up, only Motor Activity Log scores demonstrated sustained gains. Heterogeneity was moderate to high for some outcomes, and overall evidence strength was rated very low because of small sample sizes and high risk of bias.
Conclusions:
mCIMT protocols requiring fewer therapist hours but extended restraint time yield meaningful improvements in upper limb function among chronic stroke survivors, with real-world use gains persisting at follow-up. These findings suggest that optimizing, rather than maximizing, therapy intensity may improve feasibility and adherence, supporting broader clinical adoption. Further large-scale, high-quality RCTs with long-term follow-up are warranted to refine dosing guidelines and tailor interventions to patient subgroups.
