Contractures. Stretch for the treatment and prevention of contractures: what does the evidence say? Stretch for management of contractures

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1 Contractures Stretch for the treatment and prevention of contractures: what does the evidence say? Lisa Harvey Contractures are a common problem. Rehabilitation Faculty of Medicine University of Sydney, Australia Moorong Spinal Unit Royal Rehabilitation Centre Sydney, Australia standing Copied with permission

2 standing standing splinting splinting passive movements Copied with permission Trial: Ankle RCT Q. Does 30 minutes of daily stretching over 4 weeks increase ankle ROM? mean between-group difference = 0 95% CI, -3 to 3 within-subject design N = 14 recent SCI treatment and prevention Source: Arch Phys Med Rehabil (2000) 81: SCI, ankle.. 4 weeks, 30 mins daily Trial: Hamstring RCT Q. Does 30 minutes of daily stretching over 4 weeks increase hamstring extensibility? within-subject design N = 16 recent SCI treatment Copied with permission Source: Aust J Phys (2003) 7:1-13

3 mean between-group difference = 1 degree 95% CI, -2 to +5 SCI, hamstrings. 4 weeks, 30 mins daily SCI, ankle... 4 weeks, 30 mins daily Trial: Stand RCT Q. Does 30 minutes of daily stretching over 3 months increase ankle ROM? mean between-group difference = 4 95% CI = 2 to 6 within-subject design N = 20 recent SCI treatment and prevention Source: Aust J Phys (2005) 51: SCI, ankle...3 months, 30 mins daily SCI, hamstrings. 4 weeks, 30 mins daily SCI, ankle.. 4 weeks, 30 mins daily Trial: Thumb web RCT Q. Does 8 hours of daily stretching over 3 months increase thumb web-space? between subject design N = 60 SCI and TBI treatment Source: Aust J Phys (2006) 52:

4 Trial: Thumb web RCT Trial: Thumb web RCT stretch applied with splint 8 to 12 hours a day good compliance 1 subject withdrew stretch applied with splint 8 to 12 hours a day good compliance 1 subject withdrew mean between-group difference = 0 95% CI = -2 to 1 degree SCI, ankle. 3 months, 30 mins daily SCI, hamstrings... 4 weeks, 30 mins daily SCI, ankle... 4 weeks, 30 mins daily SCI, thumb. 3 months, 8 hours daily Trial: Ankle PM RCT Q. Does 20 minutes of daily passive movements over 6 months increase ankle mobility? mean between-group difference = 4 95% CI = 2 to 6 degree within subject design N = 20 established SCI treatment SCI, ankle months, 20 mins daily SCI, ankle. 3 months, 30 mins daily SCI, hamstrings... 4 weeks, 30 mins daily SCI, ankle... 4 weeks, 30 mins daily SCI, thumb. 3 months, 8 hours daily N = 240

5 Methodology and results Key points: trials (19 with sufficient data) 2. minimal susceptibility to bias 3. stretch for less than 7 months 4. primary outcome = 1 (0 to 3) Implications So what do we do? Lots of unknowns: are we being effective? what is the underlying cause? what dosage? other interventions? Self administered and incorporated into daily lives. Source: Spinal Cord (2002) 40:1-9 Self-administered stretches

6 Acknowledgements M Ben, O Katalinic, S Denis, A Byak, J Batty, J Glinsky, J Eyles, S Chee, Katte L, R Herbert, L Katte, J Crosbie, H Folpp, Eyes J, Barrat D, Barker J, Armstrong B, McClean S, A Moseley, I de Jong, S Deall, T Gwinn, S Poulter, D Simpson, D Pirronello, B Ritchie, S Marwedel, S Deall, G Goehl, J Crosbie and G Goehl 1. Moorong Spinal Unit, Royal Rehabilitation Centre Sydney 3. Spinal Unit, Prince of Wales Hospital 3. Spinal Unit, Royal North Shore Hospital 4. University of Sydney, Sydney