Stock Roland, Thrane Gyrd, Anke Audny, Gjone Ragna, Askim Torunn
Department of Physical Medicine and Rehabilitation, Trondheim University Hospital, Trondheim, Norway.
Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
Physiother Res Int. 2018 Jan;23(1). doi: 10.1002/pri.1689. Epub 2017 Jul 7.
A direct comparison between the effects of constraint-induced movement therapy (CIMT) applied early after stroke and that of CIMT applied in the chronic phase has not been conducted. This study aimed to compare the long-term effects of CIMT applied 6 months after stroke with the results of CIMT applied within 28 days post-stroke.
This study was a single-blinded, multicentre, randomized controlled trial with a crossover design. Forty-seven patients received CIMT either early (within 28 days) or 6 months after stroke. Both groups received standard rehabilitation and were tested at 5 time points. The primary outcome measure was Wolf Motor Function Test (WMFT); the secondary measures were Nine-Hole Peg Test (NHPT), the Fugl-Meyer Assessment (FMA) of the upper extremity, Stroke Impact Scale, and Modified Rankin Scale (MRS).
Compared with baseline data, both groups showed significant improvements in the primary and secondary outcome measures after 12 months. No significant differences between the 2 treatment groups were found before and after the delayed intervention group received CIMT at 6 months and during the 12-month follow-up. Both groups recovered considerably and showed only minor impairment (median FMA score of 64) after 6 months. The early intervention group showed an initially faster recovery curve of WMFT, NHPT, and MRS scores.
In contrast to most CIMT studies, our study could not find an effect of CIMT applied 6 months after stroke. Our results indicate that commencing CIMT early is as good as delayed intervention in the long term, specifically in this group of patients who might have reached a ceiling effect during the first 6 months after stroke. Nevertheless, the early CIMT intervention group showed a faster recovery curve than the delayed intervention group, which can be a clinically important finding for patients in the acute phase.
尚未对脑卒中后早期应用强制性运动疗法（CIMT）与慢性期应用CIMT的效果进行直接比较。本研究旨在比较脑卒中后6个月应用CIMT的长期效果与脑卒中后28天内应用CIMT的结果。
本研究是一项采用交叉设计的单盲、多中心、随机对照试验。47例患者在脑卒中后早期（28天内）或6个月接受CIMT。两组均接受标准康复治疗，并在5个时间点进行测试。主要结局指标是Wolf运动功能测试（WMFT）；次要指标是九孔插板测试（NHPT）、上肢Fugl-Meyer评估（FMA）、卒中影响量表和改良Rankin量表（MRS）。
与基线数据相比，两组在12个月后主要和次要结局指标均有显著改善。在延迟干预组6个月接受CIMT后及12个月随访期间，两个治疗组之间未发现显著差异。两组在6个月后均有相当程度的恢复，仅表现出轻微损伤（FMA中位数评分为64）。早期干预组的WMFT、NHPT和MRS评分最初显示出更快的恢复曲线。
与大多数CIMT研究不同，我们的研究未发现脑卒中后6个月应用CIMT的效果。我们的结果表明，早期开始CIMT与延迟干预在长期效果上一样好，特别是在这组可能在脑卒中后前6个月已达到上限效应的患者中。然而，早期CIMT干预组的恢复曲线比延迟干预组更快，这对急性期患者可能是一个具有临床重要性的发现。
