|dc.identifier.citation||111. Harvey LA, Katalinic OM, Herbert RD, Moseley AN, Lannin NA, Schurr K (2017) Stretch for the treatment and prevention of contractures. The Cochrane Database of Systematic Reviews. 2017, Issue 1. Art. No.: CD007455. DOI: 10.1002/14651858.CD007455.pub3.||en_AU|
Contractures are a common complication of neurological and non-neurological conditions, and are characterised by a reduction in joint
mobility. Stretch is widely used for the treatment and prevention of contractures. However, it is not clear whether stretch is effective.
This review is an update of the original 2010 version of this review.
The aim of this review was to determine the effects of stretch on contractures in people with, or at risk of developing, contractures.The
outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions, spasticity and adverse events.
In November 2015 we searched CENTRAL, DARE, HTA; MEDLINE; Embase; CINAHL; SCI-EXPANDED; PEDro and trials
We included randomised controlled trials and controlled clinical trials of stretch applied for the purpose of treating or preventing
Data collection and analysis
Two review authors independently selected trials, extracted data, and assessed risk of bias. The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions and adverse events. We evaluated outcomes in the short term (up to one week after the last stretch) and in the long term (more than one week). We expressed effects as mean differences (MD) or
standardised mean differences (SMD) with 95% confidence intervals (CI). We conducted meta-analyses with a random-effects model.
We assessed the quality of the body of evidence for the main outcomes using GRADE.Main results Forty-nine studies with 2135 participants met the inclusion criteria. No study performed stretch for more than seven months. Just over half the studies (51%) were at low risk of selection bias; all studies were at risk of detection bias for self reported outcomes such as pain and at risk of performance bias due to difficulty of blinding the intervention. However, most studies were at low risk of detection bias for objective outcomes including range of motion, and the majority of studies were free from attrition and selective reporting biases.
The effect of these biases were unlikely to be important, given that there was little benefit with treatment. There was high-quality
evidence that stretch did not have clinically important short-term effects on joint mobility in people with neurological conditions (MD
2°; 95% CI 0° to 3°; 26 studies with 699 participants) or non-neurological conditions (SMD 0.2, 95% CI 0 to 0.3, 19 studies with
925 participants). In people with neurological conditions, it was uncertain whether stretch had clinically important short-term effects on pain (SMD 0.2; 95% CI -0.1 to 0.5; 5 studies with 174 participants) or activity limitations (SMD 0.2; 95% CI -0.1 to 0.5; 8 studies with
247 participants). No trials examined the short-term effects of stretch on quality of life or participation restrictions in people with
neurological conditions. Five studies involving 145 participants reported eight adverse events including skin breakdown, bruising,
blisters and pain but it was not possible to statistically analyse these data.
In people with non-neurological conditions, there was high-quality evidence that stretch did not have clinically important short-term
effects on pain (SMD-0.2, 95%CI -0.4 to 0.1; 7 studies with 422 participants) and moderate-quality evidence that stretch did not have
clinically important short-term effects on quality of life (SMD 0.3, 95% CI -0.1 to 0.7; 2 studies with 97 participants). The short-term
effect of stretch on activity limitations (SMD 0.1; 95% CI -0.2 to 0.3; 5 studies with 356 participants) and participation restrictions
were uncertain (SMD -0.2; 95% CI -0.6 to 0.1; 2 studies with 192 participants). Nine studies involving 635 participants reported
41 adverse events including numbness, pain, Raynauds’ phenomenon, venous thrombosis, need for manipulation under anaesthesia,
wound infections, haematoma, flexion deficits and swelling but it was not possible to statistically analyse these data.
There was high-quality evidence that stretch did not have clinically important effects on joint mobility in people with or without
neurological conditions if performed for less than seven months. Sensitivity analyses indicate results were robust in studies at risk
of selection and detection biases in comparison to studies at low risk of bias. Sub-group analyses also suggest the effect of stretch is
consistent in people with different types of neurological or non-neurological conditions. The effects of stretch performed for periods
longer than sevenmonths have not been investigated. There was moderate- and high-quality evidence that stretch did not have clinically
important short-term effects on quality of life or pain in people with non-neurological conditions, respectively. The short-term effects
of stretch on quality of life and pain in people with neurological conditions, and the short-term effects of stretch on activity limitations
and participation restrictions for people with and without neurological conditions are uncertain.||en_AU|
|dc.publisher||The Cochrane Database of Systematic Reviews||en_AU|
|dc.title||Stretch for the treatment and prevention of contractures (Review)||en_AU|
|Appears in Collections:||Research Papers and Publications. Sydney Medical School|