Positive effects of lower extremity constraint-induced movement therapy on balance, leg strength and dual-task ability in stroke patients: a longitudinal cohort study.

There was no control group, so natural recovery, concurrent rehabilitation, or simply doing more activity cannot be ruled out as explanations for the improvements. The therapy was a package of many components, so the contribution of any single element cannot be separated. Half the participants already scored 55 or 56 on the Berg Balance Scale before treatment, so the scale had little room to show change. The average Berg Balance Scale improvement was 1.9 points, while the minimal clinically important change reported for early subacute stroke was 4 to 5 points. The same physiotherapist delivered treatment and performed assessments, creating possible observer bias, although prior test results were hidden at retesting. Forty participants did not attend the 3-month follow-up. Everyone had to be able to walk indoors without a walking aid, so results may not apply to more impaired stroke survivors. The mean age at stroke onset was 50.7 years, and the time from stroke to therapy varied from 1 month to more than 10 years, so it may not represent the wider stroke population. Home exercise compliance after treatment was only followed up orally, so the transfer package may have been unevenly performed.

The authors declared no conflicts of interest. Funding came from the Västerbotten County Council, Umeå University ALF Foundation, the Swedish Stroke Foundation, and the Northern Swedish Stroke Fund.

Do not conclude that lower-extremity constraint-induced therapy caused these improvements compared with usual care. The study had no control group, and the therapy included many components at once, so natural recovery, other rehabilitation, or the overall activity level cannot be separated from the named programme.