Phase II Randomized Controlled Trial of Constraint-Induced Movement Therapy in Multiple Sclerosis. Part 1: Effects on Real-World Function

Abstract

Background. Constraint-Induced Movement therapy (CIMT) has controlled evidence of efficacy for improving real-world paretic limb use in non-progressive physically disabling disorders (stroke, cerebral palsy). Objective. This study sought to determine whether this therapy can produce comparable results with a progressive disorder such as multiple sclerosis (MS). We conducted a preliminary phase II randomized controlled trial of CIMT versus a program of complementary and alternative medicine (CAM) treatments for persons with MS, to evaluate their effect on real-world disability. Methods. Twenty adults with hemiparetic MS underwent 35 hours of either CIMT or CAM over 10 consecutive weekdays. The primary clinical outcome was change from pretreatment on the Motor Activity Log (MAL). Results. The CIMT group improved more on the MAL (2.7 points, 95% confidence interval 2.2-3.2) than did the CAM group (0.5 points, 95% confidence interval −0.1 to 1.1; P < .001). These results did not change at 1-year follow-up, indicating long-term retention of functional benefit for CIMT. The treatments were well tolerated and without adverse events. Conclusion. These results suggest that CIMT can increase real-world use of the more-affected arm in patients with MS for at least 1 year. Clinical Trial Registration. ClinicalTrials.gov NCT01081275.

Phase II Randomized Controlled Trial of Constraint-Induced Movement Therapy in Multiple Sclerosis. Part 2: Effect on White Matter Integrity

“…Notwithstanding these limitations, the present experiment shows that there are positive changes in regional white matter indices and overall improvement in white matter integrity following CIMT in patients with MS that correspond to the large improvement in real-world use of a more-affected upper extremity in chronic stroke patients that has been previously observed (see Part 1). 28…”

“…For additional details to those given below on patients, CIMT, and clinical outcome measures, refer to Part 1. 28…”

Retention of Physical Gains in the Community Following Physical Training for Multiple Sclerosis: A Systematic Review and Implications

“…1.0) on the retention of community-based physical activity gains had used various forms of rehabilitation. 61,64,66,67 In contrast, programs that had used various forms of exercise led to small or nonexistent ES on physical activity in the community at follow-up. It is plausible that the rehabilitation trials had substantially retained posttreatment gains in the community, because they had specifically intended to improve self-care or activity in the community.…”

Movement Rehabilitation in Physiotherapy after Stroke: The Role of Constraint-Induced Movement Therapy

“…In addition to the explanations above, thus far CIMT has been extended to the rehabilitation of many conditions such as cerebral palsy, brachial plexus injury, spinal cord injury, multiple sclerosis, aphasia, and hearing impairments [32][33][34][35][36]. All these reported improvement in the outcomes of interest.…”