Systematic Review and Meta-analysis of the Efficacy of Shorter Duration Modified Constraint-Induced Movement Therapy (mCIMT) Programs.

Only 5 randomised trials met the criteria and 3 of them were rated at high risk of bias, with the other 2 raising some concerns. The review rated the certainty of the evidence very low for every outcome, because of small samples, few trials testing this specific protocol and wide variation in effect sizes. The paper reports 107 dropouts among the 239 participants, with reasons including not complying with procedures, medical problems, missing assessments, losing interest, being unreachable and transport difficulties, so the results rest on a smaller group than the headline number suggests. The comparison groups were not the same from trial to trial (usual care, conventional physiotherapy, conventional rehabilitation, traditional therapy, and Wii-based movement therapy in one trial where mCIMT was actually the control), so the trials are not all testing the same contrast. Only 3 of the 5 trials measured follow-up, at 1, 3 and 6 months, so how long any benefit lasts is largely unknown. Trials that combined mCIMT with other treatments such as botulinum toxin were excluded, so the review says nothing about patients who need those. The authors state their analysis lacked the power to test whether severity of impairment, cognitive status or motivation change how well people respond.

The authors declare no financial or non-financial conflicts of interest relating to the project. No funding source is reported in the text provided.

Do not read this as proof that a shorter, less supervised programme works as well as full-intensity CIMT. None of the trials compared mCIMT against intensive CIMT; the comparison groups were other rehabilitation or usual care, and in one trial mCIMT was the control condition. The review rated the evidence very low, 3 of the 5 trials were at high risk of bias, and most of the arm-function gains had disappeared by follow-up.