earticle

영어

Constraint-induced movement therapy (CIMT/mCIMT) and task-oriented training (TOT) represent prominent interventions for upper-limb rehabilitation following stroke; however, their relative efficacy and consistency across outcome measures remain subjects of ongoing debate. This study aimed to synthesize evidence from randomized controlled trials (RCTs) comparing CIMT and TOT for upper-extremity recovery post-stroke and to quantify pooled effects on validated impairment and activity assessments. Fourteen peer-reviewed RCTs published between 1990 and 2025 (seven investigating CIMT/mCIMT and seven investigating TOT) involving adult stroke survivors and providing sufficient data for meta-analysis were included. Adhering to a pre-specified protocol consistent with PRISMA 2020 guidelines, two independent reviewers conducted study screening, data extraction, and risk of bias assessment using the RoB 2 tool. Random-effects meta-analyses were performed to estimate pooled effect sizes; heterogeneity was evaluated using the I² statistic, and funnel plots were examined when the number of studies per outcome permitted. Primary outcomes synthesized included the MAL–Quality of Movement (MAL-QOM; mean difference [MD]), Action Research Arm Test (ARAT; standardized mean difference [SMD], Hedges’ g, based on change scores), and Fugl-Meyer Assessment for Upper Extremity (FMA-UE; SMD, Hedges’ g). Across four studies, MAL-QOM scores favored experimental interventions, predominantly CIMT variants, with a pooled MD of 0.68 (95% CI, 0.39 to 0.97; I² = 71%), indicating moderate but variable improvements in perceived real-world arm use. For ARAT (k = 3), pooled effects favored experimental treatments with an SMD of 0.95 (95% CI, 0.58 to 1.31; I² = 0%), and for FMA-UE (k = 2), the pooled SMD was 1.47 (95% CI, 0.98 to 1.97; I² = 0%), demonstrating robust enhancements in activity and impairment, respectively. The overall risk of bias was low to moderate, with masked outcome assessment commonly employed. Tests for publication bias were underpowered due to the limited number of studies (k < 10). These findings support the efficacy of intensive, task-specific upper-limb rehabilitation post-stroke. CIMT/mCIMT exhibited the most consistent benefits across impairment and activity outcomes, whereas TOT demonstrated advantages that appeared contingent upon intervention dose, fidelity of implementation, and task relevance. Clinically, rehabilitation programs that provide sufficient, progressive, and meaningful practice (utilizing CIMT when feasible and dose-matched TOT when restraint is impractical) are most likely to yield clinically significant improvements.