Stretch for treating and preventing contractures

Katalinic OM, Harvey LA, Herbert RD, Moseley AM, Lannin NA, Schurr K

Published Online:

September 8, 2010

This summary of a Cochrane review presents what we know from research about the effect of stretch interventions for contractures.

The review shows that stretch is not effective for the treatment and prevention of contractures.

We do not have precise information about side effects. Possible side effects include pain, and skin redness or breakdown.

What are contractures and what is stretch?

Contractures are characterised by the inability to move a joint freely. Contractures may be a complication of neurological conditions including stroke, spinal cord injury, traumatic brain injury and cerebral palsy. They are also commonly associated other conditions including rheumatoid arthritis, surgery and burns. They interfere with activities of daily living and can cause pain, sleep disturbances and pressure areas, and can also result in unsightly deformities.

Stretch is widely used for the treatment and prevention of contractures. The aim of stretch is to increase joint mobility. Stretch can be administered with splints and positioning programs, or with casts which are changed at regular intervals (serial casts). Alternatively, stretch can be self-administered or applied manually by therapists.

Abstract (click to read)

Background:

Contractures are a common complication of neurological and musculoskeletal 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.

Objectives:

To determine the effects of stretch on contractures in people with, or at risk of, contractures.

Search strategy:

Electronic searches were conducted on CENTRAL, DARE, HTA (The Cochrane Library); MEDLINE; CINAHL; EMBASE; SCI-EXPANDED; and PEDro (April 2009).

Selection criteria:

Randomised controlled trials and controlled clinical trials of stretch applied for the purpose of treating or preventing contractures were included.

Data collection and analysis:

Two review authors independently selected trials, extracted data, and assessed risk of bias. The primary outcomes of interest were joint mobility and quality of life. The secondary outcomes were pain, spasticity, activity limitation and participation restriction. Outcomes were evaluated immediately after intervention, in the short term (one to seven days) and in the long term (> one week). Effects were expressed as mean differences or standardised mean differences with 95% confidence intervals (CI). Meta-analyses were conducted with a random-effects model.

Main results:

Thirty-five studies with 1391 participants met the inclusion criteria. No study performed stretch for more than seven months. In people with neurological conditions, there was moderate to high quality evidence to indicate that stretch does not have clinically important immediate (mean difference 3 °; 95% CI 0 to 7), short-term (mean difference 1 °; 95% CI 0 to 3) or long-term (mean difference 0 °; 95% CI -2 to 2) effects on joint mobility. The results were similar for people with non-neurological conditions. For all conditions, there is little or no effect of stretch on pain, spasticity, activity limitation, participation restriction or quality of life.

Authors' conclusions:

Stretch does not have clinically important effects on joint mobility in people with, or at risk of, contractures if performed for less than seven months. The effects of stretch performed for periods longer than seven months have not been investigated.

This record should be cited as:

Katalinic OM, Harvey LA, Herbert RD, Moseley AM, Lannin NA, Schurr K. Stretch for the treatment and prevention of contractures. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD007455. DOI: 10.1002/14651858.CD007455.pub2

Assessed as up to date:

April 15, 2009

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Musculoskeletal Group

Arthritis topics:

Rheumatoid Arthritis > Rehabilitation and exercise

Health topics:

Rheumatology > Osteoarthritis > Rehabilitation

Rheumatology > Rheumatoid arthritis > Rehabilitation & exercise

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Independent high-quality evidence for health care decision making

Stretch for treating and preventing contractures

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