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Background: Constraint-Induced Movement Therapy (CIMT) is a treatment modality originally intended for impaired arm and hand function following unilateral brain damage, such as stroke. Extensive research has shown that CIMT may effectively enhance upper-extremity motor function with a good carry-over effect to activity levels and the improvements sustained at long-term follow-up. However, the impact of CIMT on hemiplegic shoulder pain (HSP) and Health-related Quality of Life (HRQoL) has not been adequately investigated and clinical implementation of CIMT has thus far been limited. The CIMT concept has eventually been adapted to treat lower extremity deficits (LE-CIMT) focusing on gait and balance, however currently with limited evidence.

Aim: The overall aim of this thesis was to investigate treatment effects of CIMT in an outpatient clinical setting with focus on HSP, motor function, balance, leg muscle strength and HRQoL after stroke.

Methods: A longitudinal cohort study was conducted at a physiotherapy clinic in Stockholm between 2000 and 2018. The CIMT treatment was delivered to all participants and consisted of high-intensity, task-specific training, six hours per weekday for two consecutive weeks. Treatment focus was on either arm/hand or gait/balance. Assessments used were the Fugl-Meyer Assessment scale for scoring shoulder pain, goniometry for passive and active shoulder ROM and B. Lindmark Motor Assessment, Berg Balance Scale, Single-Leg-Stance, one Repetition Maximum in a leg press and Timed Up and Go. All assessments were carried out pre- and post-CIMT and at 3-month follow-up. Additionally, the short form-36 (SF-36) Health Survey was administered pre-CIMT and at 3-month follow-up to assess HRQoL.

Results: Study participants were middle-aged and in the subacute and chronic post-stroke phases. In the upper extremities cohort (221 participants, median age 56 years, 62% men) we found significantly reduced shoulder pain alongside improved motor function and active and passive range of motion. Additionally, positive impacts were found on HRQoL at 3-month follow-up post-CIMT. Results demonstrated overall improvements in physical domains, with women improving significantly more in physical domains and men in mental domains.

Regarding participants in lower extremity CIMT (147 participants, median age 53 years, 68% men), the intervention demonstrated enhanced balance, leg strength and dual-task ability. Leg strength improvements were greater in the affected leg, resulting in decreased leg strength asymmetry between affected and non-affected lower extremity. Furthermore, we showed positive impacts on HRQoL, revealing improvements in the Physical Function and Vitality domains after participation in lower extremity CIMT. Improvements after both CIMT and LE-CIMT were maintained at 3-month follow-up.

Conclusion: CIMT and LE-CIMT are clinically applicable treatment modalities in an outpatient clinical setting with positive impacts on HSP, motor function, balance and leg strength as well as improved self-assessed health-related quality of life among predominantly middle-aged individuals in a chronic stage post-stroke.