ORIGINAL ARTICLE   Open access

European Journal of Physical and Rehabilitation Medicine 2023 April;59(2):136-44

DOI: 10.23736/S1973-9087.23.07683-9

Copyright © 2023 THE AUTHORS

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language: English

Lower-extremity constraint-induced movement therapy improved motor function, mobility, and walking after stroke

Ingela MARKLUND ^{1, 2}, Annika SEFASTSSON ^{1, 3}, Brynjar FURE ^{2, 4}, Maria KLÄSSBO ², Per LIV ⁵, Britt-Marie STÅLNACKE ¹, Xiaolei HU ¹ ✉

¹ Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden; ² Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden; ³ Liljeholmskliniken, Stockholm, Sweden; ⁴ School of Medical Sciences, Örebro University, Örebro, Sweden; ⁵ Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

BACKGROUND: To regain the ability to walk is one of the most commonly stated goals for people who have had a stroke due to its importance in everyday life. Walking ability affects patients’ mobility, self-care, and social lives. Constraint-induced movement therapy (CIMT) is known to be effective in improving upper extremity outcomes post-stroke. However, there is insufficient evidence regarding its efficacy in improving lower extremity outcomes.
AIM: To investigate whether a highly intensive CIMT for lower extremity (LE-CIMT) function post-stroke can improve motor function, functional mobility, and walking ability. Furthermore, it also aimed to investigate whether age, gender, stroke type, more-affected side, or time after stroke onset affect the efficacy of LE-CIMT on walking ability outcomes.
DESIGN: Longitudinal cohort study.
SETTING: Outpatient clinic in Stockholm, Sweden.
POPULATION: A total of 147 patients mean age 51 years (68% males; 57% right-sided hemiparesis), at the sub-acute or chronic phases post-stroke who had not previously undergone LE-CIMT.
METHODS: All patients received LE-CIMT for 6 hours per day over 2 weeks. The Fugl-Meyer Assessment (FMA) of the lower extremity, Timed Up and Go (TUG) test, Ten-Meter Walk Test (10MWT), and six-Minute Walk Test (6MWT) were used to assess functional outcomes before and directly after the 2-week treatment was complete as well at 3-month post-intervention.
RESULTS: Compared to baseline values, FMA (P<0.001), TUG (P<0.001), 10MWT (P<0.001) and 6MWT (P<0.001) scores were statistically significantly improved directly after the LE-CIMT intervention. These improvements persisted at the 3-month post-intervention follow-up. Those who completed the intervention 1-6 months after stroke onset had statistically significant larger improvements in 10MWT compared to those who received the intervention later than 6 months after stroke onset. Age, gender, stroke type, and more-affected side did not impact 10MWT results.
CONCLUSIONS: In an outpatient clinic setting, high-intensity LE-CIMT statistically significant improved motor function, functional mobility, and walking ability in middle-aged patients in the sub-acute and chronic post-stroke phases. However, studies with more robust designs need to be conducted to deepen the understanding of the efficacy of LE-CIMT.
CLINICAL REHABILITATION IMPACT: High-intensity LE-CIMT may be a feasible and useful treatment option in outpatient clinics to improve post-stroke walking ability.

KEY WORDS: Stroke rehabilitation; Exercise; Lower extremity; Physical therapy modalities