The effects of stretching in spasticity: a systematic review.
OBJECTIVE
To investigate the general effect of stretching on spasticity and to explore the complexity of stretching in patients with spasticity.


METHODS
Two researchers independently performed a systematic literature search using the databases: Medline, PEDro, Cochrane library, Web of Science, CINAHL, and Allied and Complementary Medicine.


METHODS
Studies on adults receiving a stretching technique to reduce spasticity were included.


METHODS
Randomized controlled trials (RCTs) were assessed on the PEDro scale for methodologic quality. Thirteen items from the CONSORT list and the Critical Appraisal Skills Program guideline were used to assess the methodologic quality of the other studies.


RESULTS
RCTs (n=10) and other clinical trials (n=11) were included. The methodologic quality of the RCTs was low, varying between 4 and 8 on the PEDro scale. All studies show great diversity at the levels of methodology, population, intervention, and outcome measures making a meta-analysis not feasible. Both manual and mechanical stretching methods were studied. Stretching protocols were generally inadequately described and poorly standardized. The outcome measures used often assessed impairments such as available range of motion but were unable to distinguish between neural and nonneural components of spasticity. Associated functional benefits were not usually investigated. Although there is some positive evidence supporting the immediate effects of 1 stretching session, it remains unclear how long these effects abide and its long-term consequences.


CONCLUSIONS
There is a wide diversity in studies investigating the effects of stretching on spasticity, and the available evidence on its clinical benefit is overall inconclusive. We recognize the need for consensus on a paradigm for stretching and for good-quality studies. Future research should address this issue and should investigate the clinical importance of the short- and long-term effects.
School of Life Sciences, Oxford Brookes University, Oxford, UK. T.Bovendeerdt@brookes.ac.uk
Thamar J
TJ
Bovend'Eerdt
Meredith
M
Newman
Karen
K
Barker
Helen
H
Dawes
Cosetta
C
Minelli
Derick T
DT
Wade
D006801:Humans; D009128:Muscle Spasticity / Q000503:physiopathology / Q000517:prevention & control / Q000534:rehabilitation*; D052580:Muscle Stretching Exercises; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D016896:Treatment Outcome