Occupation-based intervention versus rote exercise in modified constraint-induced movement therapy for patients with median and ulnar nerve injuries: a randomized controlled trial. (August 2017)

• Record Type: Journal Article
• Authors: Rostami, Hamid Reza; Akbarfahimi, Malahat; Hassani Mehraban, Afsoon; Akbarinia, Ali Reza; Samani, Susan
• Is Part Of: Clinical rehabilitation. Volume 31:Number 8(2017)
• Page Start: 1087
• Page End: 1097
• Publication Date: 2017-08
• Subjects: Constraint-induced movement therapy -- median nerve -- ulnar nerve -- occupation-based intervention -- rote exercise; Medical rehabilitation -- Periodicals; 617.03
• DOI: 10.1177/0269215516672276
• Languages: English
• ISSNs: 0269-2155

Abstract

Objective: To investigate effect of practice type during modified constraint-induced movement therapy on hand function in patients with chronic median and ulnar nerve injuries. Design: A prospective, single-blinded, randomized controlled clinical trial. Setting: Participants' private home. Subjects: A convenience sample of 36 outpatient participants allocated randomly to three equal groups. Interventions: Intervention groups underwent 3-hour intensive training of affected hand each day, 3-day a week, 4-week in association with immobilisation of healthy hand: occupation-based group practiced meaningful occupations while rote exercise-based group performed rote exercises during constraint-induced movement therapy. Control group performed different activities with affected hand for 1.5-hour each day during 4-week without restriction of healthy hand. Main measures: A blinded assessor tested Canadian occupational performance measure, box and block, Static two-point discrimination, disabilities of arm, shoulder, hand questionnaire, and self-assessment manikin in a random order across sessions 3-time as baseline (pre-test), after 4-week intervention (post-test), and 1-month after intervention period (follow up). Results: Scores significantly changed in intervention groups compared to control. Despite significantly more improvement in occupation-based than rote exercise-based group in subjective measures at post-test and follow up (Canadian occupational performance measure: mean change 4.7 vs. 2.1 for performance, P < 0.001 and mean change 5.3 vs. 2.6 for satisfaction, P < 0.001), it was significant just at follow up for box and block and static two-point discrimination. Conclusions: Practice content of constraint-induced movement therapy is a critical part of its effectiveness on improving outcomes following peripheral nerve repair in favour of occupation-based intervention in present study.