Effectiveness of stretch for the treatment and prevention of contractures in people with neurological conditions: a systematic review.
BACKGROUND
Contractures are a disabling complication of neurological conditions that are commonly managed with stretch.


OBJECTIVE
The purpose of this systematic review was to determine the effectiveness of stretch for the treatment and prevention of contractures. The review is part of a more-detailed Cochrane review. Only the results of the studies including patients with neurological conditions are reported here.


METHODS
Electronic searches were conducted in June 2010 in the following computerized databases: Cochrane CENTRAL Register of Controlled Trials, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA), MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, SCI-EXPANDED, and Physiotherapy Evidence Database (PEDro).


METHODS
The review included randomized controlled trials and controlled clinical trials of stretch applied for the purposes of treating or preventing contractures in people with neurological conditions.


METHODS
Two reviewers independently selected studies, extracted data, and assessed risk of bias. The primary outcome measures were joint mobility (range of motion) and quality of life. Secondary outcome measures were pain, spasticity, activity limitation, and participation restriction. Meta-analyses were conducted using random-effects models.


RESULTS
Twenty-five studies met the inclusion criteria. These studies provide moderate-quality evidence that stretch has a small immediate effect on joint mobility (mean difference=3°, 95% confidence interval [CI]=0° to 5°) and high-quality evidence that stretch has little or no short-term or long-term effects on joint mobility (mean difference=1° and 0°, respectively, 95% CI=0° to 3° and -2° to 2°, respectively). There is little or no effect of stretch on pain, spasticity, and activity limitation.


CONCLUSIONS
No studies were retrieved that investigated the effects of stretch for longer than 6 months.


CONCLUSIONS
Regular stretch does not produce clinically important changes in joint mobility, pain, spasticity, or activity limitation in people with neurological conditions.
Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Owen M
OM
Katalinic
Lisa A
LA
Harvey
Robert D
RD
Herbert
D016001:Confidence Intervals; D003286:Contracture / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy; D053580:Muscle Strength; D052580:Muscle Stretching Exercises / Q000379:methods*; D018482:Muscle, Skeletal; D009422:Nervous System Diseases / Q000150:complications / Q000534:rehabilitation*; D016017:Odds Ratio; D010146:Pain / Q000209:etiology; D059408:Pain Management; D017060:Patient Satisfaction; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular