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

Myint 2008.

Methods Randomisation by drawing sealed envelopes, other details were not provided
 Blinded of outcome assessor
 Post‐treatment withdrawals: 10%; follow‐up withdrawals: 7.5%
 Single centre, outpatients
Participants China
Recruited from 3 hospitals with rehabilitation facilities
43 participants: 23 intervention, 20 control
Inclusion criteria: cerebrovascular accident between 2 to 16 weeks; 10° of active extension to the metacarpophalangeal and interphalangeal joints 20° at wrist
Exclusion criteria: severe aphasia, high risk of fall, cerebellar stroke and severe shoulder pain affecting therapy
Mean age (SD): intervention group: 63.4 (13.6) years, control group: 63.9 (12.2) years
 % women: intervention group 56%, control group: 60%
Stroke details: ischaemic or haemorrhagic; 48% with right hemiparesis in treatment group, 70% with right hemiparesis in control group
Time since stroke, mean (SD): intervention group 1.27 (0.7) months, control group 1.5 (0.95) months
Interventions CIMT versus control
CIMT: adaptive task practice (shaping)
Amount of restraint: 90% of waking hours
Anatomical region restraint: arm and hand
Control: bimanual task, compensatory techniques for ADL strength, range of motion, positioning and mobility training
Session duration: 4 hours per day, 5 days per week, 2 weeks for each group
Outcomes Measures pre/post treatment and follow‐up at 12 months
  • Motor function: functional test for hemiparetic upper extremity, ARAT

  • Perceived arm motor function: MAL

  • Dexterity: 9HPT

  • ADL measure: modified BI

Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: "subjects were randomized by drawing sealed envelopes which were filled at random with indication of which intervention group the patient was allocated to"
Allocation concealment (selection bias) Unclear risk Insufficient information to permit judgment
Blinding (performance bias and detection bias) 
 All outcomes Low risk Quote: "The observer was blinded"
Incomplete outcome data addressed? (Post‐treatment) High risk 5/28 missing from intervention group (due to transport problem, inadequate home support; others changed their mind about trial participation); 0/20 missing participants in the control group. Reasons for missing data outcomes possibly related to the true effect, with imbalance across intervention and control groups