title: Conventional versus neutral positioning in central neurological disease: a multicenter randomized controlled trial.
abstract: BACKGROUND
  Severe immobility due to lesions of the brain necessitates therapeutic positioning over the long term. There is little scientific evidence concerning the efficacy of different positioning methods. This clinical trial compares the effects of conventional positioning (CON) with those of positioning in neutral (LiN).
  
  
  METHODS
  A prospective, multicenter, investigator-blinded, randomized, controlled trial was performed on a total of 218 non-ambulatory patients (underlying disease: stroke, 141 patients; hypoxic brain damage, 28; traumatic brain injury, 20; other, 29). The subjects were randomly assigned to either LiN (105 patients) or CON (113 patients) and stratified within each of these two positioning concepts to five different positions. They remained in the assigned positions for two hours. The primary endpoint was change in the passive range of motion (PROM) of the hip joints. Secondary endpoints were change in the PROM of the shoulder joints and patient comfort.
  
  
  RESULTS
  Patients in the LiN group had a significantly better PROM of the hips after positioning than those in the CON group (difference, 12.84°; p<0.001; 95% confidence interval [CI], 5.72°-19.96°). The same was true for PROM of shoulder flexion (11.85°; p<0.001; 95% CI, 4.50°-19.19°) and external rotation (7.08°; p<0.001; 95% CI: 2.70°-11.47°). 81% of patients in the LiN group reported their comfort level as good, compared to only 38% in the CON group (p<0.001).
  
  
  CONCLUSIONS
  Positioning severely immobilized patients in LiN for two hours improved passive hip and shoulder mobility and patient comfort compared to conventional positioning. Further studies are needed to determine whether prolonged LiN positioning might improve rehabilitation and quality of life, prevent pressure sores, or ease nursing care.
authors: Movement Disorders Section, Department of Neurology, Hannover Medical School, Hannover, Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Department of Medical Statistics, University Medical Center Göttingen.
authors: Heidrun
authors: H
authors: Pickenbrock
authors: Vera U
authors: VU
authors: Ludwig
authors: Antonia
authors: A
authors: Zapf
authors: Dirk
authors: D
authors: Dressler
mesh_terms: D000368:Aged; D001317:Austria; D001930:Brain Injuries / Q000150:complications* / Q000451:nursing*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D010243:Paralysis / Q000209:etiology* / Q000451:nursing*; D056888:Patient Positioning / Q000379:methods*; D003668:Pressure Ulcer / Q000209:etiology / Q000517:prevention & control*; D016037:Single-Blind Method; D016896:Treatment Outcome
references: J Neurol. 2002 Sep;249(9):1254-62
references: 12242550
references: J Clin Nurs. 2011 Sep;20(17-18):2633-44
references: 21702861
references: Arch Phys Med Rehabil. 2008 Jun;89(6):1146-54
references: 18503813
references: Disabil Rehabil. 2007 Sep 30;29(18):1442-8
references: 17729091
references: J Adv Nurs. 2000 Aug;32(2):286-91
references: 10964174
references: Stroke. 1988 May;19(5):604-7
references: 3363593
references: N Am J Sports Phys Ther. 2010 Sep;5(3):98-110
references: 21589666
references: Clin Rehabil. 2009 Aug;23(8):681-6
references: 19482894
references: Int J Nurs Stud. 1992 Nov;29(4):355-69
references: 1428601
references: Int J Sports Phys Ther. 2012 Jun;7(3):306-13
references: 22666645
references: Stroke. 1998 Aug;29(8):1612-7
references: 9707202
references: Physiother Res Int. 2000;5(4):241-8
references: 11129666
references: Stroke. 1997 Nov;28(11):2139-44
references: 9368554
references: BMJ Open. 2013 Aug 14;3(8):null
references: 23945730
references: Arch Phys Med Rehabil. 1986 Aug;67(8):514-6
references: 3741075
references: Arch Phys Med Rehabil. 2005 Feb;86(2):230-4
references: 15706548
references: Clin Rehabil. 2006 Apr;20(4):277-86
references: 16719026
references: Heart Lung. 2012 Nov-Dec;41(6):536-45
references: 22819601
references: Dtsch Arztebl Int. 2013 Aug;110(33-34):550-6
references: 24069079
references: Ann Intern Med. 2013 Mar 5;158(5 Pt 2):410-6
references: 23460098
references: JAMA. 2006 Aug 23;296(8):974-84
references: 16926357
references: Clin Rehabil. 2006 Aug;20(8):656-67
references: 16944823
references: J Pharmacol Pharmacother. 2010 Jul;1(2):100-7
references: 21350618
references: BMC Musculoskelet Disord. 2010;11:194
references: 20807405