Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS): A single-center RCT
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BACKGROUND: Constraint-induced movement therapy (CIMT) is among the most developed training approaches for motor restoration of the upper extremity (UE). METHODS: Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS) was a single-blind phase II trial of CIMT during acute inpatient rehabilitation comparing traditional UE therapy with dose-matched and high-intensity CIMT protocols. Participants were adaptively randomized on rehabilitation admission, and received 2 weeks of study-related treatments. The primary endpoint was the total Action Research Arm Test (ARAT) score on the more affected side at 90 days after stroke onset. A mixed model analysis was performed. RESULTS: A total of 52 participants (mean age 63.9 +/- 14 years) were randomized 9.65 +/- 4.5 days after onset. Mean NIHSS was 5.3 +/- 1.8; mean total ARAT score was 22.5 +/- 15.6; 77% had ischemic stroke. Groups were equivalent at baseline on all randomization variables. As expected, all groups improved with time on the total ARAT score. There was a significant time x group interaction (F = 3.1, p < 0.01), such that the high intensity CIT group had significantly less improvement at day 90. No significant differences were found between the dose-matched CIMT and control groups at day 90. MRI of a subsample showed no evidence of activity-dependent lesion enlargement. CONCLUSION: Constraint-induced movement therapy (CIMT) was equally as effective but not superior to an equal dose of traditional therapy during inpatient stroke rehabilitation. Higher intensity CIMT resulted in less motor improvement at 90 days, indicating an inverse dose-response relationship. Motor intervention trials should control for dose, and higher doses of motor training cannot be assumed to be more beneficial, particularly early after stroke.
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A 3-arm early rehabilitation trial testing upper limb constraint regimens (n = 52) found that a higher amount of training was inferior to lower-dose usual care.
“Interestingly, a 3-arm early rehabilitation trial testing upper limb constraint regimens, although small (n = 52), also found that a higher amount of training was inferior to lower-dose usual care.18”
From Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT) (2016) · cites this paper as [18]
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- Authors
- Dromerick, A. W., Lang, C. E., Birkenmeier, R. L., Wagner, J. M., Miller, J. P., Videen, T. O., Powers, W. J., Wolf, S. L., & Edwards, D. F.
- Affiliations
- MedStar National Rehabilitation Hospital (US)
- University of North Carolina at Chapel Hill (US)
- Venue
- Neurology
- Published
- 2009-07-21
- Volume
- 73
- Issue
- 3
- Pages
- 195-201
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC2715572
- OpenAlex
- W1967063999
- Cited by
- 399
- References
- 36
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 7 · 2023: 20 · 2022: 18 · 2021: 20 · 2020: 20 · 2019: 25 · 2018: 29 · 2017: 29 · 2016: 25 · 2015: 25 · 2014: 41 · 2013: 29 · 2012: 42
- FWCI
- 30.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- James S. McDonnell Foundation (21002032)
- National Institutes of Health
- National Institute of Neurological Disorders and Stroke (R01NS041261, 1 RO1 NS41261-01A1)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Cerebral Palsy and Movement Disorders
- Keywords
- constraint-induced movement therapy, stroke rehabilitation, upper limb motor recovery, dose-response relationship, acute inpatient rehabilitation, ischemic stroke, Action Research Arm Test, lesion expansion
- MeSH terms
- Stroke Rehabilitation, Activities of Daily Living, Aged, Arm, Brain Ischemia, Exercise Therapy, Female, Hand, Humans, Functional Laterality, Male, Middle Aged, Paresis, Restraint, Physical, Time, Time Factors, Single-Blind Method, Treatment Outcome, Muscle, Skeletal, Recovery of Function, Stroke, Physical Therapy Modalities
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