Wolf Steven L, Thompson Paul A, Winstein Carolee J, Miller J Phillip, Blanton Sarah R, Nichols-Larsen Deborah S, Morris David M, Uswatte Gitendra, Taub Edward, Light Kathye E, Sawaki Lumy
Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Ga 30322, USA.
Stroke. 2010 Oct;41(10):2309-15. doi: 10.1161/STROKEAHA.110.588723. Epub 2010 Sep 2.
Although constraint-induced movement therapy (CIMT) has been shown to improve upper extremity function in stroke survivors at both early and late stages after stroke, the comparison between participants within the same cohort but receiving the intervention at different time points has not been undertaken. Therefore, the purpose of this study was to compare functional improvements between stroke participants randomized to receive this intervention within 3 to 9 months (early group) to participants randomized on recruitment to receive the identical intervention 15 to 21 months after stroke (delayed group).
Two weeks of CIMT was delivered to participants immediately after randomization (early group) or 1 year later (delayed group). Evaluators blinded to group designation administered primary (Wolf Motor Function Test, Motor Activity Log) and secondary (Stroke Impact Scale) outcome measures among the 106 early participants and 86 delayed participants before delivery of CIMT, 2 weeks thereafter, and 4, 8, and 12 months later.
Although both groups showed significant improvements from pretreatment to 12 months after treatment, the earlier CIMT group showed greater improvement than the delayed CIMT group in Wolf Motor Function Test Performance Time and the Motor Activity Log (P<0.0001), as well as in Stroke Impact Scale Hand and Activities domains (P<0.0009 and 0.0214, respectively). Early and delayed group comparison of scores on these measures 24 months after enrollment showed no statistically significant differences between groups.
CIMT can be delivered to eligible patients 3 to 9 months or 15 to 21 months after stroke. Both patient groups achieved approximately the same level of significant arm motor function 24 months after enrollment. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00057018.
尽管强制性运动疗法（CIMT）已被证明可改善中风幸存者在中风后早期和晚期的上肢功能，但尚未对同一队列中在不同时间点接受该干预的参与者进行比较。因此，本研究的目的是比较随机分配在中风后3至9个月接受该干预的中风参与者（早期组）与随机分配在中风后15至21个月接受相同干预的参与者（延迟组）之间的功能改善情况。
随机分组后立即（早期组）或1年后（延迟组）为参与者提供为期两周的CIMT。对分组情况不知情的评估人员在106名早期参与者和86名延迟参与者接受CIMT之前、之后2周以及之后4、8和12个月，对主要（Wolf运动功能测试、运动活动日志）和次要（中风影响量表）结局指标进行评估。
尽管两组从治疗前到治疗后12个月均显示出显著改善，但早期CIMT组在Wolf运动功能测试执行时间和运动活动日志方面的改善程度大于延迟CIMT组（P<0.0001），在中风影响量表的手部和活动领域也是如此（分别为P<0.0009和0.0214）。入组24个月后，两组在这些指标上的得分比较显示，两组之间无统计学显著差异。
CIMT可在中风后3至9个月或15至21个月提供给符合条件的患者。两组患者在入组24个月后均达到了大致相同水平的显著上肢运动功能改善。临床试验注册网址：http://www.clinicaltrials.gov。唯一标识符：NCT00057018。
