The Effectiveness of Modified Constraint Induced Movement Therapy on Upper Limb Function in Children with Hemiplegic Cerebral Palsy. A systematic review and meta-analysis

Objective: To assess the effectiveness of Modified Constraint Induced Movement Therapy (mCIMT) in improving upper limb function and grip strength in children with hemiplegic cerebral palsy (CP). Methods: A comprehensive search was conducted from inception to August 2024. Eligibility criteria were studies evaluating the effectiveness of mCIMT on upper limb function in children with hemiplegic CP aged over 2 years. The following data was extracted from each study: participant characteristics, intervention, outcome measures, follow-up, and key findings. The risk of bias and the quality of the evidence were evaluated using the PEDro scale and the Grading of Recommendations Assessment Development and Evaluation (GRADE), respectively. A meta-analysis using a random-effect model was performed, and standardized mean difference (SMD) with a 95% confidence interval (CI) was estimated for upper limb function and grip strength. Results: A total of 25 studies )1115 children) were included. PEDro scale revealed twelve good-quality studies, eight fair-quality studies, and five poor-quality studies. The currently available evidence showed a significant large effect of mCIMT in improving upper limb function (SMD 1.14 [95% CI 0.46 to 1.83]; P =0.001; 12 studies; 454 children; very-low-quality evidence) and significant medium effect in improving grip strength (SMD 0.63 [95% CI 0.12 to 1.14]; P=0.02; 3 studies; 92 children; low-quality evidence). Conclusion: mCIMT could improve upper limb function and grip strength in children with hemiplegic CP. However, due to the low and very low quality of evidence, further high-quality trials are needed to confirm these effects.

Publication History

Received: 04 February 2025

Accepted after revision: 14 May 2025

Accepted Manuscript online:
20 May 2025