Constraint-Induced Movement Therapy in Acute Stroke Nursing: Timing, Safety, Motor Recovery, and Nurse-Facilitated Implementation

Constraint-induced movement therapy (CIMT) is an established upper-limb rehabilitation approach after stroke, but its initiation during the acute phase raises unresolved questions about treatment dose, eligibility, safety, and delivery across multidisciplinary stroke units. This evidence-informed narrative review critically examines randomized trials, systematic reviews, meta-analyses, and clinical guidance relevant to CIMT and modified CIMT (mCIMT), emphasizing nurse-facilitated integration into acute stroke care. Publications first available on or before 30 June 2026 were identified from PubMed, ScienceDirect, publisher pages, citations, and evidence syntheses; authenticated Scopus/Web of Science searches and exhaustive screening were not performed. Stroke phases were distinguished using consensus definitions (acute: days 1–7; early subacute: day 7 to 3 months). Early pilot trials suggested feasibility in selected patients; however, the VECTORS randomized trial found no advantage of dose-matched CIMT over conventional training and less 90-day motor improvement after a high-intensity very-early protocol. Later-phase trials and inpatient meta-analyses support upper-limb improvements in selected populations, although certainty and direct applicability to the first week after stroke remain limited. A 2026 trial of mCIMT combined with a dynamic orthosis is promising but cannot establish general acute-phase safety. Nursing priorities include monitoring neurological and physiological stability, supporting meaningful graded practice, preventing falls and fatigue, promoting adherence, and documenting real-world arm use alongside therapist-led goals. CIMT should be individualized and embedded in multidisciplinary rehabilitation rather than delivered as an unsupervised restraint intervention. Prospective trials must establish optimal timing, dose, safety, and the independent contribution of nurse-facilitated delivery.