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Does the use of a constraint mitten to encourage use of the hemiplegic upper limb improve arm function in adults with subacute stroke?

Surrey Primary Care Trust, Department of Physiotherapy, Farnham Hospital, Farnham, Surrey, alison.burns{at}nhs.net

Jane Burridge

School of Health Professions and Rehabilitation Sciences, University of Southampton, Southampton

Ruth Pickering

Pickering School of Medicine, University of Southampton and Ruth Turk School of Health Professions and Rehabilitation Sciences, University of Southampton, Southampton, UK

Objective: To evaluate the effect of a constraint mitten, worn on the unaffected upper limb, on the arm and hand function of participants with hemiplegia. To estimate the sample size for a future trial.

Design: An A-B-A design.

Setting: Inpatient, outpatient and domiciliary setting.

Subjects Ten participants with mild to moderate residual upper limb hemiparesis, between 1 and 12 months post stroke.

Intervention: Following a two-week baseline period, 10 participants were advised to wear the constraint mitten on the unaffected upper limb for 9 waking hours/day for two weeks to encourage use of the hemiplegic arm. Existing levels of therapy continued during the whole study.

Main measures: The primary outcome measure was the Action Research Arm Test. At the end of the intervention phase participants completed a questionnaire. Participants also recorded their daily use of the constraint mitten during the intervention phase.

Results: A mean improvement in the Action Research Arm Test score of 4.0 points (95% confidence interval 1.7 to 6.2; P=00.016) was found during the intervention phase after correcting for background recovery. Mean compliance was 6.7 hours/day (74%), 90% of participants were positive about the intervention and would recommend the treatment to other stroke survivors, although 50% were relieved to stop the mitten-wearing phase.

Conclusions: The use of a constraint mitten in upper limb stroke rehabilitation may be a useful adjunct to enhance functional recovery with minimal additional resources. The positive findings from this preliminary study warrant a larger randomized controlled trial of 200 participants in total.

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