Evaluating the Literature in Research

Abstract
This article examines literature related to the EBP problem of using the mCIMT intervention to help stroke patients regain motor function. Two studies are examined for their potential use in the EBP project. The first provides quantitative data obtained from a randomized controlled trial in which the mCIMT intervention was implemented. The second provides qualitative data obtained from in-depth, semi-structured interviews with three elderly stroke patients who underwent mCIMT to help restore motor function. The studies are examined and discussed in terms of research design, methods used, setting, participants, findings and results as well as well as relevance to the EBP; variables tested in the studies, and the implications of the findings for research and for this EBP in particularly. The studies are discussed in the context of the overall EBP project and the problem of obtaining further evidence to support the concept of mCIMT.

Keywords: mCIMT, stroke, rehabilitation, motor function stroke, CIMT

1
Research/Study
Singh and Pradhan (2013) conducted a randomized controlled trial with the focus being to determine the effectiveness of the mCIMT method among stroke patients. The study was quantitative in approach and experimental in design. It used two groups—one a control group and the other the intervention group. The intervention consisted of applying the mCIMT method; the control group received conventional rehabilitation therapy.
Method
The method used by Singh and Pradhan (2013) was the randomized controlled trial with 40 different stroke patients—half in the control group and half in the intervention group. Quantitative data was obtained from the participants, who were measured using the Wolf Motor Function Test (WMFT) and the Fugl-Meyer assessment (FMA) both at baseline and after the therapy. WMFT consisted of 17 items, 15 timed and 2 performance-based: in all, the WMFT measured joint segment movement and integrated functional movements. The FMA measured motor recovery, balance, sensation, and joint range of motion. Writs and hand functions were also evaluated. Data was analyzed via SPSS v. 16, with a t-test analysis performed to compare differences between the control group and the experimental group.
Setting/Subject
In the study by Singh and Pradhan (2013) the setting was Central Referral Hospital and STNM Hospital in Sikkim, India. Subjects numbered 40 and were selected for being stroke patients who met the following criteria: “(1) Ischemic or hemorrhagic first ever sub-acute stroke subjects referred by physician between 2 weeks and 4 weeks after the onset, (2) both genders of any age, (3) having at least 10° of active extension of each metacarpophalengeal joints, inter-phalengeal joints of all the digits and 10° wrist extension of the affected limb, (4) spasticity grade ?1 according to Modified Ashworth Scale, (5) Mini Mental State Examination ?17” (Singh & Pradhan, 2013, p. 181).
Findings/Results
The findings of the study by Singh and Pradhan (2013) were that mCIMT is an effective intervention based on the WMFT pre-test and post-test score of 28.04 ± 6.58, 13.59 ± 2.86; P =0.003; and on the FMA pre- and post-test score of 31.15 ± 6.37, 55.7 ± 6.4; P = 0.00. The data showed that CIMT did improve motor function.
Variables
In the study by Singh and Pradhan (2013) the IV was the CIMT intervention with the use of mitt, and the DV were motor recovery, balance, sensation, and joint range of motion as well as wrist and hand function, or in short measured joint segment movement and integrated functional movements.
Implications for Practice
The implication for practice obtained from the study by Singh and Pradhan (2013) is that CIMT is effective in improving motor function of stroke victims though there is no evidence to support its long term effectiveness. This means that for this EBP, the study by Singh and Pradhan (2013) supports the overall aim of the EBP but does not provide support for any long term assumptions that might be made as to the effectiveness of mCIMT in terms of efficaciousness over a long period of time. Nonetheless, it supports the argument that mCIMT is a plausibly effective method for rehabilitating stroke patients.
2
Research/Study
Borch, Thrane and Thornquist (2015) conducted a qualitative study using the interview method to obtain a better understanding of the patient perspective regarding the experience of using CIMT to improve physical functioning after a stroke. This study design was selected by the researchers in order to obtain a more detailed understanding of the phenomenon of mCIMT. By putting the experience in the words of those who underwent this method of physical therapy, the researchers aimed to provide a general assessment of the effectiveness of the mCIMT method overall.
Method
The method used by Borch et al. (2015) was the in-depth interview method, with three elderly stroke male patients serving as participants. The participants were interviewed following the conclusion of their mCIMT. The interviews were recorded and transcribed, coded and interpreted to identify themes that could help to explain whether the mCIMT method was useful or not in terms of helping stroke patients to improve mobility. The participants responded to open-ended questions in a semi-structured interview, and each was permitted to discuss areas of their experience at length, either prompted or unprompted, as the participant saw fit.
Setting/Subject
Borch et al. (2015) only used three participants from between the ages of 60 and 70 who were recently discharged from mCIMT. The setting was the rehabilitation facility where the therapy was provided. The participants were interviewed by the researchers, but it is not known whether they were available for follow-up questions or to clarify statements made during the interview process that researchers might have questions about.
Findings/Results
The finding from Borch et al. (2015) showed that the three participants all reported satisfaction with CIMT; however, they also reported “excessive muscle activity and lack of precision during fine motor activities” (p. 208), which indicates that there were problems that remained after the mCIMT method came to a close. The results of the study indicate that, for these participants, there is no clear answer to the question of whether mCIMT is more or less effective than conventional rehabilitation therapy. These data points do suggest, though, that more study is still required of CIMT, which makes this EBP project particularly relevant and important to the topic.
Variables
No variables were tested in the study by Borch et al. (2015) as it was a qualitative study and focused more on exploration of a topic rather than on testing variables.
Implication for Practice
The implication for practice obtained from the study by Borch et al. (2015) is that more study is required in order to tell if mCIMT really is effective at promoting motor function or if it is limited in terms of restoring strength and motor function to pre-stroke levels. The participants indicated that both concepts were possible, which means that this EBP needs to focus on providing its own evidence on the matter to help clarify the extent to which mCIMT is more useful, if it is, than conventional rehab therapy.
References
Borch, I. H., Thrane, G., & Thornquist, E. (2015). Modified Constraint-Induced
Movement Therapy Early After Stroke: Participants’ Experiences. European Journal of Physiotherapy, 17(4), 208-214.
Singh, P., & Pradhan, B. (2013). Study to assess the effectiveness of modified constraint-
induced movement therapy in stroke subjects: A randomized controlled trial. Annals of Indian Academy of Neurology, 16(2), 180-184. doi:10.4103/0972-2327.112461