The effect of supported standing in adults with upper motor neurone disorders: a systematic review.
OBJECTIVE
To evaluate whether supported standing can affect lower limb muscle length, spasticity, bone mineral density or the function of adults with upper motor neurone disorders.


METHODS
A search was conducted of MEDLINE, EMBASE, AMED, CINAHL and Cochrane library electronic databases; clinical trial registers via www.controlled-trials.com and complemented with citation tracking.


METHODS
Two reviewers independently evaluated eligibility and methodological quality. Class I and II studies of assisted standing for adults with stroke, multiple sclerosis, traumatic brain injury or spinal cord injury were eligible. A domain-based risk of bias approach was used to assess quality.


RESULTS
Seventeen studies were included: 11 class I and 6 class II studies involving 540 participants, of whom 73% were non-ambulant. Quality was generally low, with only two high quality trials identified. High-quality evidence suggested tilt-table standing has a small effect on preventing loss of ankle dorsiflexion. One high-quality study found a low-dose standing programme did not alter bone loss early after spinal injury. Class II low-quality evidence suggested long-term, higher dose programmes may slow bone loss. Limited evidence for the effectiveness of standing on spasticity and function was inconclusive.


CONCLUSIONS
Supported standing can prevent small losses of ankle mobility but the clinical importance of these effects is uncertain. Low-dose standing is unlikely to protect bone health.
Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK. meredith.newman@ouh.nhs.uk
Meredith
M
Newman
Karen
K
Barker
D000203:Activities of Daily Living; D000328:Adult; D015519:Bone Density; D006801:Humans; D007866:Leg / Q000503:physiopathology*; D016472:Motor Neuron Disease / Q000534:rehabilitation*; D009133:Muscular Atrophy / Q000517:prevention & control*; D010024:Osteoporosis / Q000517:prevention & control*; D016059:Range of Motion, Articular; D012656:Self-Help Devices