{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T13:52:24Z","timestamp":1793022744952,"version":"4.5.0"},"reference-count":38,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Constraint-induced movement therapy (CIMT) and bimanual training (BIT) have been commonly used to improve upper limb (ULF) in paediatric populations. This study aimed to compare the efficacy of CIMT and BIT for the recovery of ULF in youth with unilateral cerebral palsy (CP) in the immediate, short, and long term. Methods: A systematic review with a meta-analysis of randomised controlled trials (RCTs) from the PubMed\/Medline, Scopus, Web of Science, and PEDro databases was conducted. The primary outcomes were the immediate, short-, and long-term effects on ULF, and the secondary outcomes were related to occupational performance and disability. The risk of bias was assessed using the Cochrane RoB 2.0 tool by two researchers independently. Meta-analyses were performed using RevMan 5.3. Results: From the 174 records obtained, 10 RTCs comprising 418 participants were included. Favourable results were observed immediately after intervention for CIMT regarding unimanual ULF using the Quality of Upper Extremity Test (QUEST) (SMD = 1.08; 95% CI = (0.66;1.50)) and Jebsen\u2013Taylor Hand Function Test (JTHFT) (SMD = \u22120.62; 95% CI = (\u22121.23;0.00)). These results were maintained in the short term for the QUEST for dissociated movements (SMD = 1.19; 95% CI = (0.40;1.99)) and in the long term for the JTHFT (SMD = \u22120.38; 95% CI = (\u22121;0.24)). Conversely, favourable results were obtained immediately after the intervention for BIT regarding bimanual ULF using the Assisting Hand Assessment (SMD = \u22120.42; 95% CI = (\u22120.78\u20130.05)). Conclusions: CIMT could be more effective for improving unimanual ULF and BIT in youth with unilateral CP. The differences between the interventions decreased in the long term. Nevertheless, these findings should be interpreted with caution due to the variability in the intervention programmes. Further research with standardised protocols is needed.<\/jats:p>","DOI":"10.3390\/children12060804","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T09:57:48Z","timestamp":1750327068000},"page":"804","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Constraint-Induced Movement Therapy Versus Bimanual Training to Improve Upper Limb Function in Cerebral Palsy: A Systematic Review and Meta-Analysis of Follow-Ups"],"prefix":"10.3390","volume":"12","author":[{"given":"Gabriel","family":"Martin-Moreno","sequence":"first","affiliation":[{"name":"Department of Nursing and Physiotherapy, University of Cadiz, 11009 C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Moreno-Ligero","sequence":"additional","affiliation":[{"name":"Department of Nursing and Physiotherapy, University of Cadiz, 11009 C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9567-462X","authenticated-orcid":false,"given":"Alejandro","family":"Salazar","sequence":"additional","affiliation":[{"name":"Department of Statistics and Operational Research, University of Cadiz, 11510 Puerto Real, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2441-5342","authenticated-orcid":false,"given":"David","family":"Lucena-Anton","sequence":"additional","affiliation":[{"name":"Department of Nursing and Physiotherapy, University of Cadiz, 11009 C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6465-982X","authenticated-orcid":false,"given":"Jose A.","family":"Moral-Munoz","sequence":"additional","affiliation":[{"name":"Department of Nursing and Physiotherapy, University of Cadiz, 11009 C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15082","DOI":"10.1038\/nrdp.2015.82","article-title":"Cerebral palsy","volume":"2","author":"Graham","year":"2016","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1111\/dmcn.15055","article-title":"Interventions to improve physical function for children and young people with cerebral palsy: International clinical practice guideline","volume":"64","author":"Jackman","year":"2022","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1111\/dmcn.12705","article-title":"Randomized controlled trial of web-based multimodal therapy for unilateral cerebral palsy to improve occupational performance","volume":"57","author":"James","year":"2015","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1080\/0963828031000137063","article-title":"The International Classification of Functioning, Disability and Health: A new tool for understanding disability and health","volume":"25","author":"Chatterji","year":"2003","journal-title":"Disabil. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1111\/dmcn.12273","article-title":"Guidelines for future research in constraint-induced movement therapy for children with unilateral cerebral palsy: An expert consensus","volume":"56","author":"Eliasson","year":"2014","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_6","first-page":"CD004149","article-title":"Constraint-induced movement therapy in children with unilateral cerebral palsy","volume":"4","author":"Hoare","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_7","first-page":"931","article-title":"Development of hand-arm bimanual intensive training (HABIT) for improving bimanual coordination in children with hemiplegic cerebral palsy","volume":"48","author":"Charles","year":"2006","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1177\/0883073814533150","article-title":"The state of the evidence for intensive upper limb therapy approaches for children with unilateral cerebral palsy","volume":"29","author":"Sakzewski","year":"2014","journal-title":"J. Child Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11910-020-1022-z","article-title":"State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy","volume":"20","author":"Novak","year":"2020","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"133","DOI":"10.3109\/17518423.2012.702136","article-title":"Studies comparing the efficacy of constraint-induced movement therapy and bimanual training in children with unilateral cerebral palsy: A systematic review","volume":"16","author":"Dong","year":"2013","journal-title":"Dev. Neurorehabilit."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1177\/0269215517698834","article-title":"Efficacy of constraint-induced movement therapy compared with bimanual intensive training in children with unilateral cerebral palsy: A systematic review","volume":"31","author":"Tervahauta","year":"2017","journal-title":"Clin. Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/PEP.0000000000000438","article-title":"Comparing Unimanual and Bimanual Training in Upper Extremity Function in Children with Unilateral Cerebral Palsy","volume":"29","author":"Klepper","year":"2017","journal-title":"Pediatr. Phys. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"144","DOI":"10.4212\/cjhp.v68i2.1440","article-title":"Systematic Reviews: What Do You Need to Know to Get Started?","volume":"68","author":"Charrois","year":"2015","journal-title":"Can. J. Hosp. Pharm."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Schardt, C., Adams, M.B., Owens, T., Keitz, S., and Fontelo, P. (2007). Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med. Inform. Decis. Mak., 7.","DOI":"10.1186\/1472-6947-7-16"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref_18","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, ACADEMIC PRESS, INC.. [2nd ed.]."},{"key":"ref_19","unstructured":"Higgins, J.P.T., and Green, S. (2025, June 12). Identifying and Measuring Heterogeneity. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration. Available online: https:\/\/training.cochrane.org\/sites\/training.cochrane.org\/files\/public\/uploads\/resources\/Handbook5_1\/Handbook4.2.6Sep2006.pdf."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1177\/1545968311402508","article-title":"Bimanual training and constraint-induced movement therapy in children with hemiplegic cerebral palsy: A randomized trial","volume":"25","author":"Gordon","year":"2011","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"672","DOI":"10.5014\/ajot.2012.004622","article-title":"Functional Impact of Constraint Therapy and Bimanual Training in Children with Cerebral Palsy: A Randomized Controlled Trial","volume":"66","author":"Brandao","year":"2012","journal-title":"Am. J. Occup. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ridd.2014.10.050","article-title":"Comparison of dosage of intensive upper limb therapy for children with unilateral cerebral palsy: How big should the therapy pill be?","volume":"37","author":"Sakzewski","year":"2015","journal-title":"Res. Dev. Disabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1177\/1545968311400093","article-title":"Equivalent retention of gains at 1 year after training with constraint-induced or bimanual therapy in children with unilateral cerebral palsy","volume":"25","author":"Sakzewski","year":"2011","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Friel, K.M., Ferre, C.L., Brandao, M., Kuo, H.C., Chin, K., Hung, Y.C., Robert, M.T., Flamand, V.H., Smorenburg, A., and Bleyenheuft, Y. (2021). Improvements in Upper Extremity Function Following Intensive Training Are Independent of Corticospinal Tract Organization in Children With Unilateral Spastic Cerebral Palsy: A Clinical Randomized Trial. Front. Neurol, 12.","DOI":"10.3389\/fneur.2021.660780"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1177\/0883073812443004","article-title":"Unimanual and bimanual intensive training in children with hemiplegic cerebral palsy and persistence in time of hand function improvement: 6-month follow-up results of a multisite clinical trial","volume":"28","author":"Fedrizzi","year":"2013","journal-title":"J. Child Neurol."},{"key":"ref_26","first-page":"181","article-title":"Effectiveness of constraint induced movement therapy as compared to bimanual therapy in upper motor function outcome in child with hemiplegic cerebral palsy","volume":"32","author":"Zafer","year":"2016","journal-title":"Pak. J. Med. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.arcped.2021.11.017","article-title":"Comparing the effects of modified constraint-induced movement therapy and bimanual training in children with hemiplegic cerebral palsy mainstreamed in regular school: A randomized controlled study","volume":"29","year":"2022","journal-title":"Arch. Pediatr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"7206205010","DOI":"10.5014\/ajot.2018.025981","article-title":"Effectiveness of modified constraint-induced movement therapy compared with bimanual therapy home programs for infants with hemiplegia: A randomized controlled trial","volume":"72","author":"Chamudot","year":"2018","journal-title":"Am. J. Occup. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"24","DOI":"10.3109\/01942638.2014.925027","article-title":"Efficacy of Constraint-Induced Movement Therapy and Bimanual Training in Children with Hemiplegic Cerebral Palsy in an Educational Setting","volume":"35","author":"Gelkop","year":"2015","journal-title":"Phys. Occup. Ther. Pediatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1016\/j.apmr.2014.03.025","article-title":"Improvement of upper extremity motor control and function after home-based constraint induced therapy in children with unilateral cerebral palsy: Immediate and long-term effects","volume":"95","author":"Chen","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Hoare, B.J., Imms, C., Rawicki, H.B., and Carey, L. (2010). Modified constraint-induced movement therapy or bimanual occupational therapy following injection of Botulinum toxin-A to improve bimanual performance in young children with hemiplegic cerebral palsy: A randomised controlled trial methods paper. BMC Neurol., 10.","DOI":"10.1186\/1471-2377-10-58"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.ridd.2012.11.011","article-title":"Motor learning curve and long-term effectiveness of modified constraint-induced movement therapy in children with unilateral cerebral palsy: A randomized controlled trial","volume":"34","author":"Geerdink","year":"2013","journal-title":"Res. Dev. Disabil."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Gee, B.M., Leonard, S., Lloyd, K.G., Gerber, L.D., Quick, H., Raschke, T., Yardley, J., and Earl, J.D. (2022). Exploring the Intensity, Frequency, and Duration of Pediatric Constraint Induced Movement Therapy Published Research: A Content Analysis. Children, 9.","DOI":"10.3390\/children9050700"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e1111","DOI":"10.1542\/peds.2008-3335","article-title":"Systematic review and meta-analysis of therapeutic management of upper-limb dysfunction in children with congenital hemiplegia","volume":"123","author":"Sakzewski","year":"2009","journal-title":"Pediatrics"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e1664","DOI":"10.1542\/peds.2012-2051","article-title":"Structural Neuroplastic Change After Constraint-Induced Movement Therapy in Children With Cerebral Palsy","volume":"131","author":"Sterling","year":"2013","journal-title":"Pediatrics"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Cao, J., Khan, B., Hervey, N., Tian, F., Delgado, M.R., Clegg, N.J., Smith, L., Roberts, H., Tulchin-Francis, K., and Alexandrakis, G. (2015). Evaluation of cortical plasticity in children with cerebral palsy undergoing constraint-induced movement therapy based on functional near-infrared spectroscopy. J. Biomed. Opt., 20.","DOI":"10.1117\/1.JBO.20.4.046009"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hsu, C.W., Kang, Y.N., and Tseng, S.H. (2019). Effects of therapeutic exercise intensity on cerebral palsy outcomes: A systematic review with meta-regression of randomized clinical trials. Front. Neurol., 10.","DOI":"10.3389\/fneur.2019.00657"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1590\/S1677-54492011000400001","article-title":"Sample size in clinical and experimental trials","volume":"10","author":"Miot","year":"2011","journal-title":"J. Vasc. Bras."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/6\/804\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:55:14Z","timestamp":1760032514000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/6\/804"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,19]]},"references-count":38,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["children12060804"],"URL":"https:\/\/doi.org\/10.3390\/children12060804","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,19]]}}}