Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke - The EXCITE randomized clinical trial
Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke - The EXCITE randomized clinical trial
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DOI：
10.1001/jama.296.17.2095
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发表时间：
2006-11-01
影响因子：
120.7
通讯作者：
Nichols-Larsen, Deborah
中科院分区：
文献类型：
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作者：
Wolf, Steven L.;Winstein, Carolee J.;Nichols-Larsen, Deborah
上下文单站点研究表明，在中风后1年以上的患者进行约束诱导的运动疗法（CIMT）为期2周的计划，他们维持某种手和腕部运动可以改善上肢功能，至少持续1年。为了比较一项为期2周的CIMT多站点计划与常规和习惯护理对在前3到9个月内首次中风的上肢功能改善的效果。肢体约束诱导的治疗评估（EXTITE）试验是2001年1月至2003年1月之间在美国7个学术机构进行的前瞻性，单盲，随机，多站点临床试验。分配接受CIMT（n = 106；在从事重复的任务练习和用偏瘫手）或通常和习惯护理（n = 116;从结束正式康复后，从没有治疗到药理或物理治疗干预措施不等）；通过性别，prestroke主导侧，中风的一侧和偏臂功能水平对患者进行分层。梅恩结果测量狼运动功能测试（WMFT），这是实验室时间和基于强度的能力和运动质量的度量（功能能力） ），以及运动活动日志（MAL），一种测量了30个常见的日常活动的量度。从基线到12个月的回归，CIMT组的进步比对照组的改进更大WMFT性能时间（平均时间从19.3秒减少到9.3秒[降低52％]，从24.0秒降低到17.7秒[26％降低]；组间差异，34％[95％置信区间{CI}，12％，12％ -51％]; p <.001）和使用量（0-5级别，从1.21增加到2.13 1.65;组间差异0.43 [95％CI，0.05-0.80]； p <.001）和运动质量，0.48 [95％CI，0.13-0.84]; p <.001）。 CIMT组的自我感知手功能难度（冲程冲击量表）与对照组的降低为10.1（组间差异，9.42 [9.42 [95％CI，0.27-18.57]; p =降低10.1，CIMT组的减少了19.5。 .05）。在过去3到9个月内中风的患者之间的判定，CIMT在ARM运动功能方面产生了统计学意义和临床相关的改进持续至少1年。
Context Single-site studies suggest that a 2-week program of constraint-induced movement therapy (CIMT) for patients more than 1 year after stroke who maintain some hand and wrist movement can improve upper extremity function that persists for at least 1 year.Objective To compare the effects of a 2-week multisite program of CIMT vs usual and customary care on improvement in upper extremity function among patients who had a first stroke within the previous 3 to 9 months.Design and Setting The Extremity Constraint Induced Therapy Evaluation (EXCITE) trial, a prospective, single-blind, randomized, multisite clinical trial conducted at 7 US academic institutions between January 2001 and January 2003.Participants Two hundred twenty-two individuals with predominantly ischemic stroke.Interventions Participants were assigned to receive either CIMT (n = 106; wearing a restraining mitt on the less-affected hand while engaging in repetitive task practice and behavioral shaping with the hemiplegic hand) or usual and customary care (n = 116; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions); patients were stratified by sex, prestroke dominant side, side of stroke, and level of paretic arm function.Main Outcome Measures The Wolf Motor Function Test (WMFT), a measure of laboratory time and strength-based ability and quality of movement (functional ability), and the Motor Activity Log (MAL), a measure of how well and how often 30 common daily activities are performed.Results From baseline to 12 months, the CIMT group showed greater improvements than the control group in both the WMFT Performance Time (decrease in mean time from 19.3 seconds to 9.3 seconds [52% reduction] vs from 24.0 seconds to 17.7 seconds [26% reduction]; between-group difference, 34% [95% confidence interval {CI}, 12%-51%]; P < .001) and in the MAL Amount of Use (on a 0-5 scale, increase from 1.21 to 2.13 vs from 1.15 to 1.65; between-group difference, 0.43 [95% CI, 0.05-0.80]; P < .001) and MAL Quality of Movement (on a 0-5 scale, increase from 1.26 to 2.23 vs 1.18 to 1.66; between-group difference, 0.48 [95% CI, 0.13-0.84]; P < .001). The CIMT group achieved a decrease of 19.5 in self-perceived hand function difficulty (Stroke Impact Scale hand domain) vs a decrease of 10.1 for the control group (between-group difference, 9.42 [95% CI, 0.27-18.57]; P = .05).Conclusion Among patients who had a stroke within the previous 3 to 9 months, CIMT produced statistically significant and clinically relevant improvements in arm motor function that persisted for at least 1 year.