The EXCITE Stroke Trial: Comparing Early and Delayed Constraint-Induced Movement Therapy

• Authors: Steven L Wolf, Emory University; Paul A. Thompson, University of South Dakota; Carolee J. Winstein, University of Southern California, Los Angeles; J. Phillip Miller, Washington University; Sarah Blanton, Emory University; Deborah S. Nichols-Larsen, The Ohio State University; David M. Morris, University of Alabama at Birmingham; Gitendra Uswatte, University of Alabama at Birmingham; Edward Taub, University of Alabama at Birmingham; Kathye E. Light, University of Florida; Lumy Sawaki, University of Kentucky
• Journal Title: Stroke
• Volume: Volume 41, Number 10
• Publisher: American Heart Association | 2010-10, Pages 2309-2315
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1161/STROKEAHA.110.588723
• Subjects: Health Sciences, Rehabilitation and Therapy
• Keywords: stroke; upper extremity; constraint induced movement therapy; forced use; rehabilitation

Abstract

Background and Purpose Although constraint-induced movement therapy (CIMT) has been shown to improve upper extremity function in stroke survivors at both early and late stages post-stroke, the comparison between participants within the same cohort but receiving the intervention at different time points has not been undertaken. Therefore, the purpose of this study was to compare functional improvements between stroke participants randomized to receive this intervention within 3–9 months (early group)to participants randomized upon recruitment to receive the identical intervention 15–21 months post-stroke(delayed group). Methods Two weeks of CIMT was delivered to participants immediately after randomization (early group) or one year later (delayed group). Evaluators blinded to group designation administered primary (Wolf Motor Function Test [WMFT], Motor Activity Log [MAL]) and secondary (Stroke Impact Scale [SIS]) outcome measures among the 106 early participants and 86 delayed participants prior to delivery of CIMT, two weeks thereafter and 4, 8 and 12 months later. Results While both groups showed significant improvements from pretreatment to 12 months post-treatment, the earlier CIMT group showed greater improvement than the delayed CIMT group in WMFT Performance Time and the MAL (P’s < .0001) as well as in Stroke Impact Scale Hand and Activities domains (P <. 0009 and .0214, respectively). Early and delayed group comparison of scores on these measures 24 months after enrollment, showed no statistically significant differences between groups. Conclusions CIMT can be delivered to eligible patients 3 to 9 months or 15 to 21 months following stroke. Both patient groups achieved approximately the same level of significant arm motor function 24 months after enrollment. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00057018