Abstract
Bovend'Eerdt TJ, Newman M, Barker K, Dawes H, Minelli C, Wade DT. The effects of stretching
in spasticity: a systematic review.
Objectives
To investigate the general effect of stretching on spasticity and to explore the complexity
of stretching in patients with spasticity.
Data Sources
Two researchers independently performed a systematic literature search using the databases:
Medline, PEDro, Cochrane library, Web of Science, CINAHL, and Allied and Complementary
Medicine.
Study Selection
Studies on adults receiving a stretching technique to reduce spasticity were included.
Data Extraction
Randomized controlled trials (RCTs) were assessed on the PEDro scale for methodologic
quality. Thirteen items from the CONSORT list and the Critical Appraisal Skills Program
guideline were used to assess the methodologic quality of the other studies.
Data Synthesis
RCTs (n=10) and other clinical trials (n=11) were included. The methodologic quality
of the RCTs was low, varying between 4 and 8 on the PEDro scale. All studies show
great diversity at the levels of methodology, population, intervention, and outcome
measures making a meta-analysis not feasible. Both manual and mechanical stretching
methods were studied. Stretching protocols were generally inadequately described and
poorly standardized. The outcome measures used often assessed impairments such as
available range of motion but were unable to distinguish between neural and nonneural
components of spasticity. Associated functional benefits were not usually investigated.
Although there is some positive evidence supporting the immediate effects of 1 stretching
session, it remains unclear how long these effects abide and its long-term consequences.
Conclusions
There is a wide diversity in studies investigating the effects of stretching on spasticity,
and the available evidence on its clinical benefit is overall inconclusive. We recognize
the need for consensus on a paradigm for stretching and for good-quality studies.
Future research should address this issue and should investigate the clinical importance
of the short- and long-term effects.
Key Words
List of Abbreviations:
AMED (Allied and Complementary Medicine), CASP (Critical Appraisal Skills Program), MS (multiple sclerosis), RCT (randomized controlled trial), ROM (range of motion)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 05, 2008
Footnotes
Support by Joan Warren (private charity trust).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
Published online June 5, 2008 at www.archives-pmr.org.
Identification
Copyright
© 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
