Baldwin Cathryn R, Harry Amy J, Power Lynda J, Pope Katherine L, Harding Katherine E
Learning and Teaching Directorate, Eastern Health, Box Hill, Victoria, Australia.
Community Rehabilitation Program, Eastern Health, Angliss Hospital, Upper Ferntree Gully, Victoria, Australia.
Aust Occup Ther J. 2018 Dec;65(6):503-511. doi: 10.1111/1440-1630.12488. Epub 2018 Jun 19.
BACKGROUND/AIM: The National Stroke Foundation recommends that Occupational Therapists use Constraint-Induced Movement Therapy (CIMT) with stroke survivors that experience an upper limb deficit. CIMT involves constraining the unaffected upper limb coupled with intensive therapy. The aim of this study was to evaluate the feasibility and effectiveness of a modified, low intensity version of CIMT (mCIMT) provided within usual resources of an Australian community rehabilitation setting.
A pilot randomised control trial (n = 19) was conducted with stroke survivors referred for community rehabilitation. Participants were randomly assigned to either mCIMT or usual care. Both groups received six one-hour outpatient Occupational Therapy sessions (focussed on upper limb rehabilitation) over a two-week period. The intervention group (mCIMT) were asked to wear a constraint device on their unaffected hand for 90% of their waking hours and were provided with a home exercise program based on CIMT principles. Participants were included if they had some active upper limb movement, no significant cognitive deficits and sufficient balance. Outcome measures included upper limb function (WMFT) and participation (MAL) evaluated at baseline, immediately following the two-week intervention period and at four-week follow-up.
Only a very small proportion of patients met the eligibility criteria. There were no differences between groups, with the exception of a small increase in reported upper extremity use in functional tasks at post-intervention assessment when compared to the usual care group.
Modified CIMT can be applied to a typical Australian community rehabilitation setting, to treat upper limb deficits in stroke survivors. The resources used for mCIMT largely equalled usual care, with no differences in outcomes, suggesting that the intervention is feasible and potentially beneficial. However, there were very few stroke survivors who met participation criteria, indicating that demand for the intervention is limited.
背景/目的：国家中风基金会建议职业治疗师对存在上肢功能障碍的中风幸存者采用强制性运动疗法（CIMT）。CIMT包括限制未受影响的上肢并结合强化治疗。本研究的目的是评估在澳大利亚社区康复环境的常规资源范围内提供的改良低强度CIMT（mCIMT）的可行性和有效性。
对转介至社区康复的中风幸存者进行了一项试点随机对照试验（n = 19）。参与者被随机分配至mCIMT组或常规护理组。两组在两周内均接受六次为期一小时的门诊职业治疗（专注于上肢康复）。干预组（mCIMT）被要求在清醒时间的90%佩戴限制装置于未受影响的手上，并根据CIMT原则提供家庭锻炼计划。如果参与者有一些上肢主动运动、无明显认知缺陷且平衡能力足够，则纳入研究。结局指标包括在基线、两周干预期结束后即刻以及四周随访时评估的上肢功能（WMFT）和参与度（MAL）。
只有极少数患者符合纳入标准。除了与常规护理组相比，干预后评估中报告的功能性任务中上肢使用略有增加外，两组之间没有差异。
改良CIMT可应用于典型的澳大利亚社区康复环境，以治疗中风幸存者的上肢功能障碍。用于mCIMT的资源在很大程度上等同于常规护理，结局无差异，表明该干预措施可行且可能有益。然而，符合参与标准的中风幸存者极少，表明对该干预措施的需求有限。
