Effectiveness of Constraint-Induced Movement Therapy on Upper-Limb Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Etisam Wahid; Malije Henry Ezepue; Salwa Ali; Rida Latif; Muhammad Hassan Ali Khan; Muqaddas Yaqoob; Shahzad Ahmad; Ayesha Nisar

doi:10.61919/vn8ep590

Authors

Etisam Wahid Lecturer- Physical Therapy, University of Veterinary and Animal Sciences, Swat, KP, Pakistan Author
Malije Henry Ezepue Clinical Physiotherapist, University of Montana, Missoula, Montana, United States of America Author
Salwa Ali Rehab Trainee, Saidu Group of Teaching Hospital, Saidu Sharif, Swat, KP, Pakistan Author
Rida Latif Physiotherapist, Saidu Group of Teaching Hospital, Saidu Sharif, Swat, KP, Pakistan Author
Muhammad Hassan Ali Khan Physiotherapist, Bahria University, Karachi, Pakistan Author
Muqaddas Yaqoob Lecturer, Swat Institute of Rehabilitation and Medical Science, Swat, KP, Pakistan Author
Shahzad Ahmad Assistant Professor – Physical Therapy, University of Veterinary and Animal Sciences, Swat, KP, Pakistan Author
Ayesha Nisar Physiotherapist, Mahaban Paraplegic & Rehab Center, Topi, Swabi, Pakistan Author

DOI:

https://doi.org/10.61919/vn8ep590

Keywords:

Cerebral palsy; Constraint-Induced Movement Therapy; Modified Constraint-Induced Movement Therapy; Upper-limb function; Pediatric rehabilitation; Randomized controlled trial; Systematic review; Meta-analysis.

Abstract

Background: Cerebral palsy is frequently associated with persistent upper-limb impairment, particularly among children with unilateral or hemiplegic involvement. Constraint-Induced Movement Therapy is a neuroplasticity-based rehabilitation approach designed to improve functional use of the more affected upper limb through restraint of the less affected limb and intensive task-oriented practice. However, contemporary randomized evidence remains heterogeneous, and adjunctive CIMT studies require separate interpretation. Objective: To evaluate the effectiveness of Constraint-Induced Movement Therapy on upper-limb function in children and adolescents with cerebral palsy through a systematic review and meta-analysis of randomized controlled trials. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and PEDro for English-language randomized controlled trials published from January 2015 to December 2025. Eligible studies included children or adolescents with cerebral palsy receiving CIMT, modified CIMT, expanded CIMT, or CIMT-based rehabilitation. Risk of bias was assessed using the Cochrane RoB 2 tool. Standardized mean differences using Hedges’ g were pooled under a random-effects model where trials directly compared CIMT with non-CIMT control interventions. Adjunctive CIMT trials were synthesized separately. Results: Five randomized controlled trials involving 269 participants were included. Two trials with 110 participants were included in the primary meta-analysis. The pooled effect favored CIMT but was not statistically significant (Hedges’ g = 1.53, 95% CI −1.35 to 4.40), with considerable heterogeneity (I² = 96.6%). Three adjunctive trials evaluated rTMS or virtual reality combined with CIMT. rTMS showed promising additive effects, whereas virtual reality did not demonstrate clear superiority over CIMT alone. Conclusion: CIMT remains a promising intervention for pediatric upper-limb rehabilitation in cerebral palsy, but current evidence is limited by few directly comparable trials, imprecision, and substantial heterogeneity. Larger standardized randomized trials are needed to establish effect magnitude, optimal dosage, durability, and clinical applicability

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