02758nas a2200157   4500000000100000008004100001100001400042700001600056700001700072245013800089250001500227300001000242490000700252520229500259020004602554       2011                            d1 aHarvey L.1 aHerbert Rob1 aKatalinic O.00aEffectiveness of stretch for the treatment and prevention of contractures in people with neurological conditions: a systematic review  a2010/12/04  a11-240 v913 a<p>
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. Data Sources 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). Study Eligibility Criteria 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. Study Appraisal and Synthesis METHODS: /b&gt; 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: /b&gt; 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 degrees , 95% confidence interval [CI]=0 degrees to 5 degrees ) and high-quality evidence that stretch has little or no short-term or long-term effects on joint mobility (mean difference=1 degrees and 0 degrees , respectively, 95% CI=0 degrees to 3 degrees and -2 degrees to 2 degrees , respectively). There is little or no effect of stretch on pain, spasticity, and activity limitation. Limitations No studies were retrieved that investigated the effects of stretch for longer than 6 months. CONCLUSION: /b&gt; Regular stretch does not produce clinically important changes in joint mobility, pain, spasticity, or activity limitation in people with neurological conditions.
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