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- Published online April 1, 2011.
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© 2011
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- Owen M. Katalinic,
- Lisa A. Harvey and
- Robert D. Herbert
- O.M. Katalinic, BAppSc(Physiotherapy), is Physiotherapist, Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
- L.A Harvey, BAppSc(Physiotherapy), GradDipAppSc(ExSpSc), MAppSc(Physiotherapy), PhD, is Associate Professor, Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, University of Sydney.
- R.D. Herbert, BAppSc(Physiotherapy), MAppSc(ExSpSc), PhD, is Associate Professor, Musculoskeletal Division, The George Institute for Global Health, Sydney, New South Wales, Australia.
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- Issue 1. The conclusion is not justified because there are not enough clinical trials and the existing clinical trials have not explored all possible combinations of stretch administered to all types of joints and muscles in every type of patient with neurological conditions (as indicated in Weppler's Tables 1 and 2).
- Issue 2. The clinically important change was set without regard for factors such as the type of joint, severity of the contracture, and involved muscles.
- Issue 3. Although stretch had no effect on joint range of motion measured with a standardized torque, it may have had an effect within the muscle or on the ability of the muscle to actively generate force or on other measures of joint mobility.
- Issue 4. The review should have investigated the effects of stretch on patients' perceptions of stretch.
- Issue 5. The review did not provide an alternative suggestion for contracture management.
- Statement 1. “Many of the studies demonstrated significant positive effects of stretching….”
- Statement 2. “The 4 studies involving only the direct application of stretch showed the potential of several stretching interventions to prevent contracture formation. For example, 2 of the direct stretch studies demonstrated a significant treatment effect in contracture prevention.”
- Statement 3. “Overall, the studies involving splinting and casting suggested that these interventions are more effective in preventing and treating contractures when combined with passive stretching programs than when used alone.”
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