Constraint-Induced Movement Therapy Versus Bimanual Training to Improve Upper Limb Function in Cerebral Palsy: A Systematic Review and Meta-Analysis of Follow-Ups.
Gabriel Martin-Moreno, Marta Moreno-Ligero, Alejandro Salazar, David Lucena-Anton, Jose A Moral-Munoz
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Abstract
Background/Objectives: Constraint-induced movement therapy (CIMT) and bimanual training (BIT) have been commonly used to improve upper limb (ULF) in paediatric populations. This study aimed to compare the efficacy of CIMT and BIT for the recovery of ULF in youth with unilateral cerebral palsy (CP) in the immediate, short, and long term. Methods: A systematic review with a meta-analysis of randomised controlled trials (RCTs) from the PubMed/Medline, Scopus, Web of Science, and PEDro databases was conducted. The primary outcomes were the immediate, short-, and long-term effects on ULF, and the secondary outcomes were related to occupational performance and disability. The risk of bias was assessed using the Cochrane RoB 2.0 tool by two researchers independently. Meta-analyses were performed using RevMan 5.3. Results: From the 174 records obtained, 10 RTCs comprising 418 participants were included. Favourable results were observed immediately after intervention for CIMT regarding unimanual ULF using the Quality of Upper Extremity Test (QUEST) (SMD = 1.08; 95% CI = (0.66;1.50)) and Jebsen-Taylor Hand Function Test (JTHFT) (SMD = -0.62; 95% CI = (-1.23;0.00)). These results were maintained in the short term for the QUEST for dissociated movements (SMD = 1.19; 95% CI = (0.40;1.99)) and in the long term for the JTHFT (SMD = -0.38; 95% CI = (-1;0.24)). Conversely, favourable results were obtained immediately after the intervention for BIT regarding bimanual ULF using the Assisting Hand Assessment (SMD = -0.42; 95% CI = (-0.78-0.05)). Conclusions: CIMT could be more effective for improving unimanual ULF and BIT in youth with unilateral CP. The differences between the interventions decreased in the long term. Nevertheless, these findings should be interpreted with caution due to the variability in the intervention programmes. Further research with standardised protocols is needed.
背景/目的：约束诱导运动疗法（CIMT）和双手训练（BIT）已被广泛用于改善儿童上肢（ULF）。本研究旨在比较CIMT和BIT对青年单侧脑瘫（CP）患者ULF的近期、短期和长期恢复效果。方法：对来自PubMed/Medline、Scopus、Web of Science和PEDro数据库的随机对照试验（rct）进行系统评价和荟萃分析。主要结果是对ULF的即时、短期和长期影响，次要结果与职业表现和残疾有关。偏倚风险由两位研究者独立使用Cochrane RoB 2.0工具进行评估。采用RevMan 5.3进行meta分析。结果：从获得的174份记录中，纳入了10份rtc，包括418名参与者。使用上肢质量测试（QUEST），在CIMT干预后立即观察到对单手ULF的有利结果(SMD = 1.08；95% CI =(0.66;1.50))和捷成-泰勒手功能检验（JTHFT） (SMD = -0.62；95% ci =(-1.23;0.00))。这些结果在短期内对于解离运动的QUEST (SMD = 1.19；95% CI =(0.40;1.99))和长期的JTHFT (SMD = -0.38；95% ci =(-1;0.24)。相反，使用辅助手评估(SMD = -0.42；95% ci =(-0.78-0.05))。结论：CIMT能更有效地改善青年单侧CP患者的单侧ULF和BIT，长期来看，两种干预措施之间的差异逐渐减小。然而，由于干预方案的可变性，这些发现应谨慎解释。需要对标准化方案进行进一步研究。
期刊介绍：
Children is an international, open access journal dedicated to a streamlined, yet scientifically rigorous, dissemination of peer-reviewed science related to childhood health and disease in developed and developing countries.
The publication focuses on sharing clinical, epidemiological and translational science relevant to children’s health. Moreover, the primary goals of the publication are to highlight under‑represented pediatric disciplines, to emphasize interdisciplinary research and to disseminate advances in knowledge in global child health. In addition to original research, the journal publishes expert editorials and commentaries, clinical case reports, and insightful communications reflecting the latest developments in pediatric medicine. By publishing meritorious articles as soon as the editorial review process is completed, rather than at predefined intervals, Children also permits rapid open access sharing of new information, allowing us to reach the broadest audience in the most expedient fashion.
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