Wolf Steven L, Winstein Carolee J, Miller J Phillip, Thompson Paul A, Taub Edward, Uswatte Gitendra, Morris David, Blanton Sarah, Nichols-Larsen Deborah, Clark Patricia C
Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
Lancet Neurol. 2008 Jan;7(1):33-40. doi: 10.1016/S1474-4422(07)70294-6.
The aim of constraint-induced movement therapy (CIMT) is to promote use of a limb that is functionally impaired after a stroke. In one form of CIMT to treat upper limb impairment, use of the less severely affected arm is restricted for many hours each weekday over 2 consecutive weeks. The EXCITE trial has previously shown the efficacy of this intervention for patients 3-9 months poststroke who were followed-up for the next 12 months. We assessed the retention of improvements 24 months after the intervention.
In the EXCITE trial, 106 of 222 participants who had mild to moderate poststroke impairments were randomly assigned to receive CIMT rather than usual and customary care. We assessed this group of patients every 4 months for the primary outcome measure of impaired upper limb function, as measured with the Wolf motor function test (WMFT) and the motor activity log (MAL). Health-related quality of life, measured with the stroke impact scale (SIS), was a secondary outcome measure. Analysis was per protocol. This trial is registered with ClinicalTrials.gov, number NCT00057018.
The effects at 24 months after treatment did not decline from those at 12 months for time taken to complete the WMFT (-0.32 s, 95% CI -3.70 to 3.06), for weight lifted in the WMFT (-1.39 kg, -2.74 to -0.04), for WMFT grip strength (-4.39 kg, -6.91 to -1.86), for amount of use in the MAL (-0.17, -0.38 to 0.04), or for how well the limb was used in the MAL (-0.14, -0.34 to 0.06). The additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT, p<0.0001.
Patients who have mild to moderate impairments 3-9 months poststroke have substantial improvement in functional use of the paretic upper limb and quality of life 2 years after a 2-week CIMT intervention. Thus, this intervention has persistent benefits.
强制性运动疗法（CIMT）的目的是促进中风后功能受损肢体的使用。在一种治疗上肢损伤的CIMT形式中，在连续2周的每个工作日，对受影响较轻的手臂的使用限制数小时。EXCITE试验先前已证明这种干预措施对中风后3 - 9个月的患者有效，并在接下来的12个月进行了随访。我们评估了干预后24个月改善情况的持续性。
在EXCITE试验中，222名有轻度至中度中风后损伤的参与者中，106名被随机分配接受CIMT而非常规护理。我们每4个月对该组患者进行评估，以Wolf运动功能测试（WMFT）和运动活动日志（MAL）测量的上肢功能受损作为主要结局指标。用中风影响量表（SIS）测量的与健康相关的生活质量是次要结局指标。分析按方案进行。该试验已在ClinicalTrials.gov注册，编号为NCT00057018。
治疗后24个月时，完成WMFT的时间（-0.32秒，95%可信区间-3.70至3.06）、WMFT中举起的重量（-1.39千克，-2.74至-0.04）、WMFT握力（-4.39千克，-6.91至-1.86）、MAL中的使用量（-0.17，-0.38至0.04）或MAL中肢体的使用程度（-0.14，-0.34至0.06），其效果与12个月时相比没有下降。额外的变化是朝着治疗效果增加的方向。对于WMFT的力量成分，p<0.0001。
中风后3 - 9个月有轻度至中度损伤的患者，在接受2周的CIMT干预后2年，患侧上肢的功能使用和生活质量有显著改善。因此，这种干预具有持久的益处。
