The Journal of Korean Society of Community-Based Occupational Therapy Vol.11 No.2 pp.13-24
The Effect of Modified Constraint-Induced Movement Therapy(mCIMT) on the Improvement of Upper Motor Function in Adult Stroke Patients Using Meta Analysis
Key Words : modified Constraint-Induced Movement Therapy(mCIMT), Stroke, Upper Motor Function
Objective : This study explored researches that applied mCIMT to adult stroke patients, evaluated the effect size of mCIMT in improving upper extremity function in stroke patients. In addition, this study was conducted to use it as basic data for selection of the most appropriate treatment method by examining the modulating effect with the treatment application conditions(total restraint hour, total therapy hour, and restraint region). Method : After searching the literatures published from January 2000 to January 2021 using Pubmed, data that met the inclusion and exclusion criteria were selected, and finally 11 randomized controlled trial studies were analyzed. The evaluation tool for upper motor function was the Fugl Meyer Assessment (FMA), and effect size analysis was performed on the experimental group and the control group. Moderation effect analysis was performed to estimate the effect size for each treatment application condition, which is a moderator variable, and the publication error analysis was performed using Egger's regression test. Result : As a result of synthesizing the effects of mCIMT through 11 papers, the experimental group in which mCIMT was applied to Reum showed a larger effect size than the control group (ES=0.975, 95% CI: 0.199～1.751, p=0.004). As a result of analyzing the effect of mCIMT according to treatment application conditions, “total therapy hour” was found to be a significant moderator variable(Qb=11.90, p=0.0006), and a significant larger effect size was found in the treatment time group of less than 30 hours (ES=2.042, 95% CI: 1.227～2.857, R2=64.38%). “total restraint hour”(Qb=0.01, p=0.924) and “restraint region”(Qb=0.59, p=0.441) were not significant moderator varialbes. But in the case of “total restraint hour”, the group with less than 100 hours was found to have a significant large effect size(ES=0.998, 95% CI: 0.065～1.930), and in the case of “restraint region”, the group with limited hands had a significant large effect size(ES=1.110, 95% CI: 0.220～2.000). There was no significant relationship between the effect size and the standard error of 11 articles, indicating that there was no publication bias (bias=0.815, p=0.800). Conclusion : mCIMT is an effective occupational therapy method for improving upper motor function in stroke patients. In addition, when we make up the treatment application conditions of mCIMT, the “total therapy hour” is programmed to be less than 30 hours, the “total restraint hour” is flexibly adjusted according to the “total therapy hour”. Mixed application of methods that restriction of hands and restriction of hands and arms is proposed as an effective method for improving upper motor function in stroke patients.