title: Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury: a randomised trial.
abstract: OBJECTIVE
  Is a combination of standing, electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe brain injury?
  
  
  METHODS
  A multi-centre randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis.
  
  
  METHODS
  Thirty-six adults with severe traumatic brain injury and ankle plantarflexion contractures.
  
  
  METHODS
  All participants underwent a 6-week program. The experimental group received tilt table standing, electrical stimulation and ankle splinting. The control group received tilt table standing alone.
  
  
  METHODS
  The primary outcome was passive ankle dorsiflexion with a 12Nm torque. Secondary outcomes included: passive dorsiflexion with lower torques (3, 5, 7 and 9Nm); spasticity; the walking item of the Functional Independence Measure; walking speed; global perceived effect of treatment; and perceived treatment credibility. OUTCOME MEASURES were taken at baseline (Week 0), end of intervention (Week 6), and follow-up (Week 10).
  
  
  RESULTS
  The mean between-group differences (95% CI) for passive ankle dorsiflexion at Week 6 and Week 10 were -3 degrees (-8 to 2) and -1 degrees (-6 to 4), respectively, in favour of the control group. There was a small mean reduction of 1 point in spasticity at Week 6 (95% CI 0.1 to 1.8) in favour of the experimental group, but this effect disappeared at Week 10. There were no differences for other secondary outcome measures except the physiotherapists' perceived treatment credibility.
  
  
  CONCLUSIONS
  Tilt table standing with electrical stimulation and splinting is not better than tilt table standing alone for the management of ankle contractures after severe brain injury.
  
  
  BACKGROUND
  ACTRN12608000637347. [Leung J, Harvey LA, Moseley AM, Whiteside B, Simpson M, Stroud K (2014) Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury: a randomised trial.Journal of Physiotherapy60: 201-208].
authors.affiliation: Royal Rehabilitation Centre.
authors.forename: Joan
authors.initials: J
authors.lastname: Leung
authors.affiliation: Sydney Medical School, University of Sydney; Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, University of Sydney.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Harvey
authors.affiliation: Sydney Medical School, University of Sydney; The George Institute for Global Health.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Moseley
authors.affiliation: Liverpool Health Service.
authors.forename: Bhavini
authors.initials: B
authors.lastname: Whiteside
authors.affiliation: Westmead Hospital, Sydney, Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Simpson
authors.affiliation: Royal Rehabilitation Centre.
authors.forename: Katarina
authors.initials: K
authors.lastname: Stroud
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D003131:Combined Modality Therapy; D003286:Contracture / Q000209:etiology / Q000628:therapy*; D019468:Disease Management; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005528:Foot; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D026741:Physical Therapy Modalities; D011187:Posture / Q000502:physiology*; D013165:Splints; D018667:Tilt-Table Test; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology
keywords: Contracture; Electrical stimulation; Splinting; Stretch; Traumatic brain injury