Journal presentation .. Topic: systematic review and meta analysis on effect of CIMT lower limb

1. Presented by Suparna Bandyopadhyay
MPT (NEUROLOGY),NIHS, Kolkata
HELLO…..
More info

2. TRIAL DETAILS

3. Trial Name:
Authors:
Journal:
Year of
Publicatio
n
Issue and
volume
3
Effect of constraint-induced movement therapy on lower
extremity motor dysfunction in post-stroke patients: A
systematic review and meta-analysis
Mingze Zhou, Yang Tu, Jiarui Cui, Ping Gao, Ting Yi,
Jun Wang, Qinghong Hao, Hui Li and Tianmin Zhu
Frontiers in Neurology
2022
13 - 2022

4. Contact
info
DOI:
Country
Trial
registration
shxia18003@tongji.edu.cn
https://doi.org/10.3389/fneur.2022.1028206
China
Prospero (CRD42021277466)

5. JOURNAL DETAILS
TYPING…..
01

6. 01 03
02 04
Impact factor
Volume
Indexing
ISSN
3.4 (2022) PubMed, PubMed Central
(PMC), Scopus, Google
Scholar, DOAJ, CrossRef,
Embase, CLOCKSS
13 - 2022
Electronic ISSN
1664-2295
Frontiers in Neurology
In 2022, Frontiers was the 3rd most-cited publisher with an average of 5 citations for recent articles

7. Author Details
Mingze Zhou
Intern, Chengdu University of
Traditional Chinese Medicine
Hui Li
School of Preclinical Medicine, Chengdu
University, Chengdu, China
Conceived the study, drafted the
manuscript, reviewed and revised
the manuscript
Conceived the study, provided general
guidance to draft the protocol,
reviewed and revised the manuscript
Yang Tu
Chengdu University of Traditional
Chinese Medicine
Provided general guidance to draft the
protocol, designed the search
strategy
Conceived the study, provided general
guidance to draft the protocol,
reviewed and revised the manuscript
• Tianmin Zhu
Professor Chengdu University of Traditional
Chinese Medicine,

8. Stroke has high mortality
and disability rate
Stroke results in abnormal
movement pattern in lower limb
CIMT motor rehabilitation strategy
used to restore impaired limb motor
function & reduce learned nonuse
CIMT consist of restraining of
unaffected limb , shaping
strategy , transfer package
CIMT improves gait parameter
r, gait speed quality & quantity
of movement

9. Carry on ...
Determine the effectiveness of CIMT on impaired lower limb
function after stroke & to evaluate whether devices affect CIMT
effectiveness

10. Methodology
Here you can describe the topic of the section
Typing…..
02

11. Database
PubMed EMBASE
The Cochrane
Library
Web
of Science
China Biology
Medicine
(CBM)
China National
Knowledge
Infrastructure
(CNKI)
Wan Fang Data
The
Chinese
Science and
Technology
Periodical
Database
(VIP)

12. —Someone Famous
English
Chinese
“

13. Inclusion criteria
Studies on patients with motor
impairment of the lower limbs
after a stroke
Studies that evaluated
CIMT, modified CIMT, and any
interventions conforming to
the lower extremity CIMT core
strategy (Intensive practice of
the functional activities and restraint
of the less affected lower
extremity by the device or behavioral
procedures)
Studies that were RCTs
Studies are written in
English or Chinese

14. Unavailable studies
The study did not obtain results of
Interest
Studies one of the following types:
opinions, case reports, case series,
conference papers, editorials, abstracts, or
crossover studies

15. Outcome measures
Berg Balance
Scale
(BBS)
Fugl-Meyer
Assessment
scale on lower
limbs
(FMA-L)
Static and dynamic
balance
Lower extremity
function
10 Meter Walk
Test
(10MWT)
Gait speed
1 2 3

16. Outcome measures
Functional
Ambulation
Category
(FAC)
6 Min Walk
Test
(6-MWT)
Time Up And
Go Test
(TUGT)
4 5 6

17. Outcome measures
Modified
Barthel
Index
(MBI)
Brunnstrom
Stage Of Lower
Limb Function
Functional
Independence
Measure
(FIM)
7 8 9

18. Outcome measures
World Health
Organization
Quality Of Life
Assessment
(WHOQOL)
Stroke Specific
Quality Of Life
Questionnaire
(Ssqol)
National Institute
Of Health Stroke
Scale
(NIHSS)
10 11 12

19. Removal of
duplicate
entries
EndNote X9
Data obtaining
Author’s name,
Trial details, inclusion & exclusion criteria,
interventions for control and experimental
Group
Title and abstract screening
According to predefined inclusion &
exclusion criteria

20. The methodological quality of the included studies using the Cochrane Bias Risk
Assessment Tool

21. Data analysis
Here you can describe the topic of the section
Analyzing…..
03

22. Chi-Squared
&
I2 statistic
The interstudy heterogeneity
Sensitivity
Analyses
Explore the source of heterogeneity
Egger’s
Test
Funnel plot asymmetry
(Publication Bias)
A significant level was considered at p <0.05 & I2 statistic > 50% indicated unaccepted
variability among the included studies
P < 0.05 indicated significant publication bias

23. earths is the Sun’s mass

24. Result
Here you can describe the topic of the section
Processing….
04

25. 1
Initial data
obtained
343record from 8
database
Duplication removal
127 removed
Exclusion
182 article did not
match the inclusion
criteria
Inclusion
34 RCTS
1
2
3
4

26. Infographic
2008
subjects
34
RCTs
Outcome measure
2008
To
2021
1003
Experimen
tal group
Intervention
24 studies adopted
CIMT
9 studies CIMT +
Conventional PT
1 study CIMT+
Western medicine
 FMA (L) – 16
 BBS- 23
 10WMT-13
 Gait Speed -4
 TUGT-11
 FAC-6
 6MWT-3
 BRS -1
 MBI-14
 FIM-1
 SSQOL-2
 WHOQOL-1
 NIHSS -1

27. Methodological Quality Assessment
Unclear
High quality
11 studies
did not record
whether the
baseline was
balanced
4 studies
only
Low quality
27 studies
5-selection bias
4- performance
bias
2-Detection bias
16- attrition bias

28. CIMT vs conventional PT for Motor recovery
Intervention
Control group:
Conventional PT
Experimental
group: CIMT
Venus Mars Neptune
Activity method
10 studies
628
participants
Result
Pooled data analysis showed that the CIMT
group had a higher FMA L evaluation
score than the conventional physiotherapy
group.
over all effect size is 3.81
Forest plot (CIMT VS Conventional PT) in motor
recovery

29. CIMT vs conventional PT for Balance
Intervention
Control group:
Conventional PT
Experimental
group: CIMT
Venus Mars Neptune
Activity method
16 studies
847
participants
Result
CIMT was superior to conventional
physiotherapy in improving balance function .
The MD value was 7.63
Forest plot (CIMT VS Conventional PT) in balance

30. Outcome measures
Studies were
strongly
heterogeneous
funnel plot was
asymmetric
Egger’s test also
confirmed the
publication bias
(P= 0.02)
1
2
3
35%
Mars
Despite being red, Mars is
actually a cold place
50%
Neptune
Neptune is the farthest
planet from the Sun
Activity resource
Neptune
Mars
65%
75%
Funnel plot for publication bias

31. CIMT vs conventional PT in Gait speed
Intervention
Control group:
Conventional PT
Experimental
group: CIMT
Venus Mars Neptune
Activity method 4 studies uses
10MWT
94
participants
Result
CIMT was superior to conventional
physiotherapy in improving gait speed .
Forest plot (CIMT VS Conventional PT) in Walking
speed

32. CIMT vs conventional PT in Walking speed (10MWT)
Intervention
Control group:
Conventional PT
Experimental
group: CIMT
Venus Mars Neptune
Activity method 10 studies
uses 10MWT
569
participants
Result
CIMT was superior to conventional
physiotherapy in improving walking speed.
The standard MD was 9.56
Forest plot (CIMT VS Conventional PT) in Walking
speed

33. Outcome measures
funnel plot was
Symmetric
Egger’s test also
confirmed the no
publication bias
(P= 0.351)
1
2
35%
Mars
Despite being red, Mars is
actually a cold place
50%
Neptune
Neptune is the farthest
planet from the Sun
Activity resource
Neptune
Mars
65%
75%
Funnel plot for publication bias

34. CIMT vs conventional PT in Mobility (TUGT)
Intervention
Control group:
Conventional PT
Experimental
group: CIMT
Venus Mars Neptune
Activity method 07 studies
uses 1TUGT
367
participants
Result
Pooled data analysis showed that patients in
the experimental group spent less time on the
TUGT,
with an MD value of−6.02
Forest plot (CIMT VS Conventional PT) in TUGT

35. CIMT vs conventional PT in Mobility (FAC)
Intervention
Control group:
Conventional PT
Experimental
group: CIMT
02 studies
uses FAC
190
participants
Result
MD value is 0.89
Forest plot (CIMT VS Conventional PT) in FAC

36. CIMT vs conventional PT in ADL (MBI)
Intervention
Control group:
Conventional PT
Experimental
group: CIMT
08studies uses
MBI
473
participants
Result
MD value is 9.86
Forest plot (CIMT VS Conventional PT) in MBI

37. CIMT vs conventional PT in ADL (FIM)
Intervention
Control group:
Conventional PT
Experimental
group: CIMT
01 studies
uses FIM
96
participants
Result
MD value is 25.30
Forest plot (CIMT VS Conventional PT) in FIM
The above results indicate that patients in the CIMT group had higher scores than
those in the conventional physiotherapy group

38. CIMT vs conventional PT in QOL (SSQOL)
Intervention
Control group:
Conventional PT
Experimental
group: CIMT
02 studies
uses SSQOL
51
participants
Result
MD value is 20.76
Forest plot (CIMT VS Conventional PT) in SSQOL

39. CIMT vs conventional PT in QOL (WHOQOL)
Intervention
Control group:
Conventional PT
Experimental
group: CIMT
01 studies
uses SSQOL
120
participants
Result
MD value is 18.70
Forest plot (CIMT VS Conventional PT) in
WHOQOL
The above results indicate that patients treated with CIMT had higher Quality of
Life scores than patients treated with conventional physiotherapy

40. CIMT plus conventional physiotherapy vs.
conventional physiotherapy in motor function
Intervention
Control group:
Conventional PT
Experimental
group: CIMT +
Conventional PT
05 studies
uses FMA L
388
participants
Result
MD value is 3.35
Forest plot (CIMT VS Conventional PT) in FMAL
Pooled analysis showed that CIMT combined with conventional physiotherapy was better than conventional
physiotherapy alone for improving the motor function of the patient’s lower limb

41. CIMT plus conventional physiotherapy vs.
conventional physiotherapy in Balance
Intervention
Control group:
Conventional PT
Experimental
group: CIMT +
Conventional PT
07 studies
uses BBS
510
participants
Result
MD value is 6.37
Forest plot (CIMT VS Conventional PT) in BBS
CIMT combined with conventional physiotherapy was superior to Conventional
physiotherapy alone for improving the balance function.

42. CIMT plus conventional physiotherapy vs.
conventional physiotherapy in gait speed (10MWT)
Intervention
Control group:
Conventional PT
Experimental
group: CIMT +
Conventional PT
02 studies use
10MWT
62
participants
Result
MD value is -12.90
Forest plot (CIMT VS Conventional PT) in 10MWT
The above results indicate that CIMT combined with conventional physiotherapy was
better than conventional physiotherapy alone for improving walking speed

43. CIMT plus conventional physiotherapy vs.
conventional physiotherapy in Mobility (6MWT)
Intervention
Control group:
Conventional PT
Experimental
group: CIMT +
Conventional PT
03 studies
uses FMA L
123
participants
Result
MD value is 93.91
Forest plot (CIMT VS Conventional PT) in 6MWT
CIMT combined with conventional physiotherapy was superior to Conventional
physiotherapy alone for improving the balance function.

44. CIMT plus conventional physiotherapy vs.
conventional physiotherapy in Mobility (TUGT)
Intervention
Control group:
Conventional PT
Experimental
group: CIMT +
Conventional PT
04 studies use
TUGT
184
participants
Result
MD value is -14.32
Forest plot (CIMT VS Conventional PT) in TUGT
CIMT combined with conventional physiotherapy was superior to Conventional
physiotherapy alone for improving the balance function.

45. CIMT plus conventional physiotherapy vs.
conventional physiotherapy in Mobility
(Weight bearing)
Intervention
Control group:
Conventional PT
Experimental
group: CIMT +
Conventional PT
01 studies use
Weight-
bearing
18
participants
Result
MD value is 5.80
Forest plot (CIMT VS Conventional PT) in Weight
bearing
CIMT combined with conventional physiotherapy is better than conventional physiotherapy
alone for improving the mobility of patients.

46. CIMT plus conventional physiotherapy vs.
conventional physiotherapy in MBI
Intervention
Control group:
Conventional PT
Experimental
group: CIMT +
Conventional PT
06 studies use
MBI
442
participants
Result
MD value is 10.41
Forest plot (CIMT VS Conventional PT) in MBI

47. CIMT plus Western medicine therapy vs.
Western medicine therapy IN FMA L
Intervention
Control group:
Western Medicine
Experimental
group: CIMT
Western Medicine
01 study
38
participants
Result
MD value is 3.50
Forest plot (CIMT VS Conventional PT)

48. Lower extremity CIMT with device vs.
lower extremity CIMT without device in FMA-L
Intervention
 12 Studies
performed
CIMT without
restraint device
 4 studies did
not use restraint
device
16
studies
38
participants
Result
MD value with restraint device 4.52
MD value without restraint device 3.37
Forest plot

49. Discussion
Fuzaro and co-workers
Silva and co-workers
2 weeks of treadmill training with CIMT,
and home exercise improves postural
balance and flexibility in stroke patient
Auwal et al
CIMT was superior to
conventional treatment only for
improving the quality of life
 Forced Use Therapy and CIMT
improve balance and gait
 Lower extremity CIMT improves
motor behavior patterns and
scores on the functional scale
This study found that CIMT improved
balance, walking speed, mobility,
activities of daily living, and QOL more
substantially than conventional
treatment and Western medicine

50. Discussion
Improve mobility
Overcome
inactivity
Improve
quality of
movement
Dos Anjos
Using a restraint device would
induce abnormal coordination
pattern
It May alter normal gait or
increase inertia in the
lower limbs
This study states that CIMT with restraint
device shows better result in FMA L score

51. Discussion
Type Of
Restraint Duration
Intensity Evaluation
CIMT intensity can directly affect the patient’s recovery time after
stroke

52. Discussion
Neuroplasticity is typically achieved in response to about 300 highly
repetitive tasks per day, typically completed in 1 h

53. Discussion
Most of the study shows that the experimental
and control group shows similar intensities
and duration of task practice.
Each study had a specific CIMT scheme For restriction
Orthotic device Elevated insole Cane Ankle mass

54. Discussion
Using an elevated insole in the lower extremity CIMT to
force a shift of the center of gravity may alter the
biomechanics of the lower extremity and impede functional
recovery.
Patients should be actively encouraged to maximize
the use of impaired limbs

55. Conclusion
This study suggests that CIMT improves lower extremity
motor function more substantially than traditional physical
therapy and Western medicine