Abstract：
BACKGROUND: While constraint-induced movement therapy is strongly recommended as an intervention for infants with unilateral cerebral palsy, the optimal dosage remains undefined. This systematic review aims to identify the most effective level of intensity of constraint-induced movement therapy to enhance manual function in infants at high risk of asymmetric brain lesions or unilateral cerebral palsy diagnosis.
METHODS: This systematic review with meta-analysis encompassed a comprehensive search across four electronic databases to identify articles that met the following criteria: randomised controlled trials, children aged 0-6 with at high risk or with unilateral cerebral palsy, and treatment involving constraint-induced movement therapy for upper limb function. Studies with similar outcomes were pooled by calculating the standardised mean difference score for each subgroup, and subgroups were stratified every 30 h of total intervention dosage (30-60, 61-90, >90 h). Risk of bias was assessed with Cochrane Collaboration\'s tool.
RESULTS: Seventeen studies were included. Meta-analyses revealed significant differences among subgroups. The 30-60 h subgroup showed a weak effect for spontaneous use of the affected upper limb during bimanual performance, grasp function, and parents\' perception of how often children use their affected upper limb. Additionally, this subgroup demonstrated a moderate effect for the parents\' perception of how effectively children use their affected upper limb.
CONCLUSIONS: Using a dosage ranging from 30 to 60 h when applying a constraint-induced movement therapy protocol holds promise as the most age-appropriate and cost-effectiveness approach for improving upper limb functional outcomes and parent\'s perception.
METHODS: This systematic review with meta-analysis encompassed a comprehensive search across four electronic databases to identify articles that met the following criteria: randomised controlled trials, children aged 0-6 with at high risk or with unilateral cerebral palsy, and treatment involving constraint-induced movement therapy for upper limb function. Studies with similar outcomes were pooled by calculating the standardised mean difference score for each subgroup, and subgroups were stratified every 30 h of total intervention dosage (30-60, 61-90, >90 h). Risk of bias was assessed with Cochrane Collaboration\'s tool.
RESULTS: Seventeen studies were included. Meta-analyses revealed significant differences among subgroups. The 30-60 h subgroup showed a weak effect for spontaneous use of the affected upper limb during bimanual performance, grasp function, and parents\' perception of how often children use their affected upper limb. Additionally, this subgroup demonstrated a moderate effect for the parents\' perception of how effectively children use their affected upper limb.
CONCLUSIONS: Using a dosage ranging from 30 to 60 h when applying a constraint-induced movement therapy protocol holds promise as the most age-appropriate and cost-effectiveness approach for improving upper limb functional outcomes and parent\'s perception.
摘要：
背景：虽然强烈建议将约束诱导运动疗法作为单侧脑瘫婴儿的干预措施，最佳剂量仍未定义。这项系统评价旨在确定约束诱导运动疗法强度的最有效水平，以增强不对称脑部病变或单侧脑瘫诊断高危婴儿的手动功能。
方法：这项具有荟萃分析的系统评价包括对四个电子数据库的全面搜索，以确定符合以下标准的文章：随机对照试验，0-6岁高危儿童或单侧脑瘫儿童，以及涉及上肢功能的约束诱导运动疗法的治疗。结果相似的研究通过计算每个亚组的标准化平均差异得分进行汇总。和亚组每30小时分层总干预剂量（30-60，61-90，>90小时）。使用CochraneCollaboration的工具评估偏倚风险。
结果：共纳入17项研究。Meta分析显示亚组之间存在显著差异。30-60h亚组在双手表现期间对自发使用受影响的上肢的影响较弱，抓取功能，以及父母对儿童使用上肢的频率的看法。此外,该亚组对父母对儿童如何有效使用受影响的上肢的看法表现出中等影响。
结论：在应用约束诱导运动治疗方案时，使用30至60小时的剂量有望成为改善上肢功能结局和父母感知的最适合年龄和成本效益的方法。
方法：这项具有荟萃分析的系统评价包括对四个电子数据库的全面搜索，以确定符合以下标准的文章：随机对照试验，0-6岁高危儿童或单侧脑瘫儿童，以及涉及上肢功能的约束诱导运动疗法的治疗。结果相似的研究通过计算每个亚组的标准化平均差异得分进行汇总。和亚组每30小时分层总干预剂量（30-60，61-90，>90小时）。使用CochraneCollaboration的工具评估偏倚风险。
结果：共纳入17项研究。Meta分析显示亚组之间存在显著差异。30-60h亚组在双手表现期间对自发使用受影响的上肢的影响较弱，抓取功能，以及父母对儿童使用上肢的频率的看法。此外,该亚组对父母对儿童如何有效使用受影响的上肢的看法表现出中等影响。
结论：在应用约束诱导运动治疗方案时，使用30至60小时的剂量有望成为改善上肢功能结局和父母感知的最适合年龄和成本效益的方法。
