Research project Implementation of evidence-based motor rehabilitation with high-intensity, task-specific training in clinical practice
The purpose of this study is to implement and evaluate evidence-based stroke rehabilitation regimes, specifically modified Constraint-Induced Movement Therapy (CIMT), to achieve optimal motor recovery and thereby improve the quality of life in stroke patients.
Annika Sefastsson
Folke Forzelius
Charlotte Otterstedt
A longitudinal cohort study was conducted among community-dwelling participants in the subacute and chronic post-stroke phases. A total of 221 participants with impaired upper extremity (UE) function and 147 participants with impaired lower extremity (LE) function received CIMT for 6 hours per day over two consecutive weeks in an outpatient clinic. Various outcomes related to functional impairments, activity, and health-related quality of life (HRQoL) were assessed pre-treatment, post-treatment, and at a three-month follow-up.
In addition to demonstrating similar effectiveness of UE-CIMT in our cohort compared to previous randomized controlled trials (RCTs), we found that UE-CIMT alleviated shoulder pain and improved shoulder range of motion and motor function. Similar to UE-CIMT, LE-CIMT improved motor function, balance, dual-task ability, strength, weight-bearing symmetry, mobility, and walking ability in the subacute and chronic post-stroke phases. These improvements after UE- and LE-CIMT were sustained at the three-month follow-up, with enhanced HRQoL across various subdomains.
Building on the compelling evidence supporting the effectiveness of UE-CIMT in research settings, we successfully implemented UE-CIMT in the outpatient setting and observed similar improvements to those reported in previous RCTs. Notably, UE-CIMT also alleviated shoulder pain while enhancing HRQoL. Although LE-CIMT has comparatively less supporting evidence, our findings suggest that it, like UE-CIMT, can improve lower extremity function and activities, even long after stroke onset, leading to sustained benefits. Our results indicate that CIMT is a feasible and effective treatment option that can be implemented in outpatient settings.
