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. 2015 Oct 8;2015(10):CD004433. doi: 10.1002/14651858.CD004433.pub3

Dahl 2008.

Methods Block randomisation, other details were not reported
 Blinded outcome assessor
 No withdrawals
 Single centre, inpatients
Participants Norway
Recruited from the Stroke Unit at Trondheim University Hospital and by announcement at hospitals and rehabilitation institutions in the neighbouring countries
30 participants: 18 intervention, 12 control
Inclusion criteria: time from onset of stroke > two weeks; score 0 to 2 points before the stroke on the modified Ranking Scale; 10° of active extension to the metacarpophalangeal and interphalangeal joints and 20° at wrist
Exclusion criteria: presence of other neurological diseases, unstable cardiovascular disease, severe depression (> 12 points on Montgomery and Aasberg Depression Rating Scale), marked neglect (line bisection more than 2 cm over the midline), life expectancy < 6 months, sequel from a previous stroke and clinically evaluated insufficient endurance to participate
Mean age (SD): intervention group: 62 (8) years, control group: 60 (12) years
 % women: intervention group 11%, control group: 42%
Stroke details: ischaemic or haemorrhagic; 78% paresis of dominant side in treatment group, 58% paresis of the dominant side in control group
Time since stroke, mean (SD): intervention group 21 (18) months, control group 26 (27) months
Interventions CIMT versus control
CIMT: personalised ADL task training of the paretic limb, training difficulty was updated with daily progress
 Amount of restraint: 90% of waking hours per day
Anatomical region restraint: hand
Control: treatment given according to each patient's need, involving both upper and lower extremity with various occupational and physical therapy approaches
Session duration: 6 hours per day in the CIMT group, unspecified duration for control group for 10 consecutive weekdays
Outcomes Measures pre/post treatment and follow‐up at 6 months
  • Motor function: WMFT

  • Perceived arm motor function: MAL

  • ADL measure: FIM2

  • Quality of life: SIS

Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Quote: "Eligible patients were block‐randomised into a CIMT group or a control group"
Allocation concealment (selection bias) Low risk Quote: "Sealed opaque envelopes were used for randomisation and the procedure was carried out by an external office"
Blinding (performance bias and detection bias) 
 All outcomes Low risk Quote: "Two independent and blinded assessors performed the assessments"
Incomplete outcome data addressed? (Post‐treatment) Low risk No missing data