Modified constraint-induced movement therapy for lower limb intervention on patients with stroke: A Scoping Review

Abstract Following the successful application of Constraint-Induced Movement Therapy (CIMT) in upper extremity rehabilitation for stroke patients, modified CIMT (mCIMT) has been introduced for lower extremity training in stroke patients. However, there is not enough evidence to prove its effectiveness in lower extremity rehabilitation. The diverse protocols of mCIMT present challenges in determining the superior approach for enhancing dyskinesia recovery. This study seeks to assess the safety and efficacy of mCIMT in lower extremity training for stroke patients and explores the essential components of mCIMT protocols to formulate an appropriate mCIMT plan for stroke patients. A literature search, following the PRISMA guidelines, was performed across four databases (PubMed, Web of Science, Scopus, PEDro) to identify clinical trials involving adult stroke patients receiving mCIMT for lower extremity movement disorders. The methodological quality of the included studies was evaluated using classifications based on study designs. According to predetermined inclusion and exclusion criteria, this review included 36 studies involving 931 patients. No serious adverse events were reported. The studies indicated that mCIMT significantly improves motor function, functional mobility, balance, lower extremity strength, weight-bearing, and walking ability. Five main types of constraint were identified. Dosage metrics include task repetition count and training duration. The use of transfer packages facilitated the translation of training effects into daily life. mCIMT for lower extremity functional recovery in stroke patients is deemed safe and feasible, contributing to the improvement of lower extremity functional impairments in stroke patients. Constraint devices are considered unsafe and unnecessary. Therefore, behavioural constraints are recommended. The repetition count of tasks is a suitable metric for assessing mCIMT dosage, and protocols with transfer packages enhance efficacy and sustainability. mCIMT holds broad prospects in stroke rehabilitation, with the need for individualized adjustments based on patient conditions to enhance effectiveness and practical value.