Exploring the Intensity,Frequency,and Duration of Published Research on Constraint-Induced Movement Therapy: A Content Analysis

BACKGROUND AND PURPOSE: Numerous scholars have conducted systematic or content-based analyses of the occupational therapy literature to explore the status of a journal (Gutman, 2010), focus and content of occupational therapy literature, and dosage related to pediatric occupational therapy practice (Gee et al., 2016). Regardless of the setting, one task of occupational therapists is to determine the dosage when establishing the plan of care for their clients. Dosage may be defined as the combination of the frequency of treatment sessions, intensity of the intervention provided, duration of the episode of care, and type of intervention or interventions applied (Gannotti et al., 2014).

A commonly used intervention for people with acute and chronic neurological conditions, constraint-induced movement therapy (CIMT), is widely accepted as an effective intervention within the profession of occupational therapy to increase upper limb function (Gillen, 2016). The purpose of this study was to explore findings related to the documented dosage—number of sessions, length of plan of care and session, type of delivery, setting, and intervention type—in published outcome studies using CIMT with adults with chronic neurological dysfunction.

METHOD: Content analysis and descriptive statistics were used. The master of occupational therapy faculty and student research team searched for refereed CIMT-based outcome studies using Google Scholar, EBSCOhost, CINAHL, MEDLINE, OTseeker, and the American Occupational Therapy Association’s Special Interest Section publications.

RESULTS: Eighty-three refereed outcome studies were found related to CIMT published from 1995 to 2015. A research design matrix was used to identify and track the reported information (number of sessions, length of plan of care and session, type of delivery, setting, intervention type) from the studies. At least two raters verified the data captured from each article with approximately 95% agreement. Seventy-six articles on CIMT outcomes met the inclusion criteria for the content analysis.

The frequency of constraint-induced movement therapy ranged from 1 to 7 days per week, with an average of 4.98 days. Duration ranged from 2 to 10 wk, with an average of 3.14 wk. Descriptive statistics related to dosage were as follows: M = 65.6 total intervention hours, M = 4.9 days/wk of CIMT, and M = 3.05 wk in duration of the overall CIMT intervention procedure. 75% of the studies documented using repetitive task-oriented training, 40% reported incorporating daily home program activities, and 97% reported constraining the nonaffected limb as part of the intervention or experimental portion of the study. Conditions for which CIMT was applied included acute, subacute, and chronic stroke; ischemic and hemorrhagic stroke; traumatic brain injury; Parkinson’s disease; and ulnar or median nerve injury. Levels of evidence ranged from randomized controlled trials to multiple-baseline single-case studies. The studies were conducted in university laboratories and inpatient and outpatient rehabilitation settings.

CONCLUSION: For occupational therapy practitioners and researchers to replicate CIMT interventions that have meaningful outcomes, documented procedures and dosages need to be available. This requirement is especially important given the increased scrutiny of interventions used by occupational therapy practitioners and the profession’s focus on evidence-based practice. This study is the first content analysis exploring the status of dosage related to CIMT. Practitioners working in neurorehabilitation regardless of setting may benefit from these findings to help shape how they prescribe CIMT to maximize gains.

References

Gannotti, M. E., Christy, J. B., Heathcock, J. C., & Kolobe, T. H. (2014). A path model for evaluating dosing parameters for children with cerebral palsy. Physical Therapy, 94, 411–421. https://doi.org/10.2522/ptj.20130022

Gillen, G. (2016). Stroke rehabilitation: A function-based approach (4th ed.). St. Louis, MO: Mosby/Elsevier.

Gee, B., Lloyd, K., Devine, N., Tyrrell, E., Evans, T., Hill, R., . . . Magalogo, K. (2016). Dosage parameters in pediatric outcome studies reported in 9 peer-reviewed occupational therapy journals from 2008 to 2014: A content analysis. Rehabilitation Research and Practice, 2016, 3580789. https://doi.org/10.1155/2016/3580789

Gutman, S. A. (2010). State of the journal, 2010. American Journal of Occupational Therapy, 64, 832–840. https://doi.org/10.5014/ajot.2010.064601