Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomised trial

• Authors: Steven L Wolf, Emory University; Carolee J. Winstein, University of Southern California; J Phillip Miller, Washington University; Paul A. Thompson, Washington University; Edward Taub, University of Alabama at Birmingham; Gitendra Uswatte, University of Alabama at Birmingham; David Morris, University of Alabama at Birmingham; Sarah Blanton, Emory University; Deborah Nichols-Larsen, The Ohio State University; Patricia C. Clark, Georgia State University
• Journal Title: Lancet Neurology
• Volume: Volume 7, Number 1
• Publisher: Elsevier: Lancet | 2008-01, Pages 33-40
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/S1474-4422(07)70294-6
• Subjects: Biology, Neuroscience; Health Sciences, Rehabilitation and Therapy; Psychology, Physiological

Abstract

Background Constraint-Induced Movement therapy (CIMT) uses a variety of treatment components, including restricted use of the better upper extremity, to promote increased use of the contralesional limb for many hours each weekday over two consecutive weeks. The EXCITE Trial demonstrated the efficacy of this intervention for patients 3-9 months post-stroke who were followed for the next 12 months. We assessed the retention of improvements through 24 months. Method Measurements were made every four months for impaired upper extremity function (Wolf Motor Function Test - WMFT and Motor Activity Log - MAL) and health related quality of life (Stroke Impact Scale - SIS) amongst 106/222 participants randomized into one arm of the EXCITE Trial in which they received CIMT rather than usual and customary care. Findings There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL. In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern. Interpretation Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate substantial improvement in functional use of the paretic upper extremity and quality of life 2 years after receiving a 2-week CIMT intervention. Thus this intervention has persistent benefits.