I am writing in regard to the recently published article by Katalinic and colleagues1 titled “Effectiveness of Stretch for the Treatment and Prevention of Contractures in People With Neurological Conditions: A Systematic Review.” I have deep respect for the authors regarding their many years of research, its technical merit, and the substantial contribution their research has made toward the understanding of the biomechanical effects of stretching. Their research and that of their colleagues have demonstrated the clinical importance of stretching in populations of healthy people2–4 and in patients with chronic pain,5 as well as in people diagnosed with neurological conditions. I was surprised, therefore, to read the conclusion of the systematic review: “Regular stretch does not produce clinically important changes in joint mobility…in people with neurological conditions.”1(p11)
How was this conclusion reached? The conclusion was based on an assessment of 18 studies.6–23 Each study was given a weighted value determined by an extensive quality evaluation (Tab. 1). The conclusion is deep enough to question the foundation upon which clinical contracture management is based,1 yet the supporting research is not extensive in any one particular area of study (Tab. 2). The conclusion is broad, yet the supporting research is not equally broad based. The 10 most heavily weighted studies6–15 accounted for 90.9% of the weight in the analysis. Most notable in Table 2 is the number of boxes that are entirely empty: the types of passive stretch applications, neurological conditions, and muscles that have not been evaluated.
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Overall Study Weightsa
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Interventions and Neurological Conditionsa
What was included in the analysis? Regular stretch was defined as passive stretching techniques only. In the analysis, splinting or casting interventions were weighted at 64.6%, direct application of stretch at 30.2%, and positioning at 5.2% (Tab. 2 …
