Preliminary Results of a Pilot Clinical Trial Using a Reimbursable Form of Constraint-induced Movement Therapy: The Keys Treatment protocol

• Published in: Archives of physical medicine and rehabilitation Vol. 105; no. 4; p. e37
• Main Authors: dos Anjos, Sarah, Bowman, Mary, Morris, David
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2024
• Subjects: Constraint-Induced Movement Therapy; Motor Dysfunction; Rehabilitation; Stroke; Upper Extremity; Upper Extremity; Constraint-Induced Movement Therapy; Stroke; Rehabilitation; Motor Dysfunction
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2024.02.102

Examine changes in use of the affected upper extremity (UE), motor function, depression, and quality of life (QOL) after an 8-week distributed form of constraint-induced movement therapy (CIMT) called the Keys Treatment protocol and investigate if an intensified 4-week version is as effective as the 8-week intervention. Pilot trial. Neuroplasticity Clinical Lab. Five adults with chronic stroke with partial movement on the affected UE. Participants received the 8-week Keys Treatment protocol, including: 22 1.5-hour sessions, distributed as follows: 4 days/week for weeks 1-4, 2 days/week for weeks 5-6, and 1 day/week for weeks 7-8; restraint mitt on the less-affected UE for 8 weeks; and administration of the transfer package. MAL, WMFT, SIS, Zung Depression Scale (ZDS), and the COPM were administered pre- (T1), during (4 weeks of intervention, T2), and post-treatment (8 weeks of intervention, T3). Participants improved in all outcomes compared to scores obtained at T1. The largest difference was observed at T2-T1 compared to T3-T2 in MAL amount of use (T2-T1: 2.2 and T3-T2: 0.6), MAL quality of movement (T2-T1: 2.3 and T3-T2: 0.2), COPM performance (T2-T1: 3.8 and T3-T2: 0.2), COPM satisfaction (T2-T1: 3.5 and T3-T2: 0.9), WMFT time in seconds (T2-T1: -0.94 and T3-T2: -0.41), ZDS (T2-T1: -2.4 and T3-T2: -1.8), SIS strength (T2-T1: 11.3 and T3-T2: 3.8), and SIS Hand Function (T2-T1: 23 and T3-T2: 7). The T2-T1 difference was higher than T3-T2 in two SIS domains: Memory (T2-T1:11.4 and T3-T2: -4.8), and Communication (T2-T1: 4.3 and T3-T2: -2.2). Different results were observed on the other SIS domains, where the T3-T2 difference was higher than T2-T1: ADL (T2-T1: 4.0 and T3-T2: 5.0), Mobility (T2-T1: 2.8 and T3-T2: 5.6), and Participation (T2-T1: 7.4 and T3-T2: 10.7). The Keys Treatment protocol improves use, motor function of the affected UE, occupational performance, mood, and QOL. The largest difference in scores was observed at T2 except for ADL performance, mobility, and social participation domains on the SIS. No conflict of interest to declare.