Phase II Randomized Controlled Trial of Constraint-Induced Movement Therapy in Multiple Sclerosis. Part 1: Effects on Real-World Function.
Victor W Mark, Edward Taub, Gitendra Uswatte and 5 others
PMID 29668399WHAT IT FOUND
Ten adults with MS who received intensive constraint-induced movement therapy reported using their weaker arm in daily life at 85% of normal levels after treatment, up from 25%.
This gain held at one year. The comparison group saw little real-world improvement.
Key findings
01Constraint-induced movement therapy produced a large improvement in self-reported real-world arm use compared to the control intervention.
02The improvement in real-world arm use was maintained at one-year follow-up, whereas the control group did not show similar gains.
03Both groups improved similarly on the laboratory-based motor function test immediately after treatment, but the constraint-induced group maintained a significant advantage at one year.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The sample size was very small (20 participants total), limiting the generalizability of the findings. Clinical testers were not masked to treatment allocation, which may have influenced subjective outcomes like the MAL. The CAM control group had more men and more individuals whose affected hand was dominant, which could affect baseline comparability. The MAL may have a ceiling effect, potentially underestimating further improvements in high-functioning patients. The study did not determine whether the benefit came from the specific CIMT techniques or the intensity of therapist contact, though the CAM group also received 3.5 hours/day.
Declared interests
The study was supported by the National Institute of Neurological Disorders and Stroke (NINDS) and the National Center for Medical Rehabilitation Research (NCMRR). The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that CIMT is superior to all forms of therapy for all MS patients. The study included only those with specific criteria (mild-moderate deficit, able to stand, reduced use of one arm) and compared it to a holistic CAM program, not standard physical therapy. Additionally, the lack of masked assessors means the large self-reported gains could be influenced by expectation or assessment bias.