Ana Paula Salazar1, Camila Pinto1, Joao Victor Ruschel Mossi2, Bruno Figueiro2, Janice Luisa Lukrafka3, Aline Souza Pagnussat4. 1. Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil. 2. Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil. 3. Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil. 4. Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil. Electronic address: alinespagnussat@gmail.com.
Abstract
OBJECTIVE: To systematically review the effects of static stretching with positioning orthoses or simple positioning combined or not with other therapies on upper-limb spasticity and mobility in adults after stroke. METHODS: This meta-analysis was conducted according to PRISMA guidelines and registered at PROSPERO. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, Scopus and PEDro databases were searched from inception to January 2018 for articles. Two independent researchers extracted data, assessed the methodological quality and rated the quality of evidence of studies. RESULTS: Three studies (57 participants) were included in the spasticity meta-analysis and 7 (210 participants) in the mobility meta-analysis. Static stretching with positioning orthoses reduced wrist-flexor spasticity as compared with no therapy (mean difference [MD]=-1.89, 95% confidence interval [CI] -2.44 to -1.34; I2 79%, P<0.001). No data were available concerning the spasticity of other muscles. Static stretching with simple positioning, combined or not with other therapies, was not better than conventional physiotherapy in preventing loss of mobility of shoulder external rotation (MD=3.50, 95% CI -3.45 to 10.45; I2 54.7%, P=0.32), shoulder flexion (MD=-1.20, 95% CI -8.95 to 6.55; I2 0%, P=0.76) or wrist extension (MD=-0.32, 95% CI -6.98 to 5.75; I2 38.5%, P=0.92). No data were available concerning the mobility of other joints. CONCLUSION: This meta-analysis revealed very low-quality evidence that static stretching with positioning orthoses reduces wrist flexion spasticity after stroke as compared with no therapy. Furthermore, we found low-quality evidence that static stretching by simple positioning is not better than conventional physiotherapy for preventing loss of mobility in the shoulder and wrist. Considering the limited number of studies devoted to this issue in post-stroke survivors, further randomized clinical trials are still needed. CLINICAL TRIAL REGISTRATION: PROSPERO (CRD42017078784).
OBJECTIVE: To systematically review the effects of static stretching with positioning orthoses or simple positioning combined or not with other therapies on upper-limb spasticity and mobility in adults after stroke. METHODS: This meta-analysis was conducted according to PRISMA guidelines and registered at PROSPERO. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, Scopus and PEDro databases were searched from inception to January 2018 for articles. Two independent researchers extracted data, assessed the methodological quality and rated the quality of evidence of studies. RESULTS: Three studies (57 participants) were included in the spasticity meta-analysis and 7 (210 participants) in the mobility meta-analysis. Static stretching with positioning orthoses reduced wrist-flexor spasticity as compared with no therapy (mean difference [MD]=-1.89, 95% confidence interval [CI] -2.44 to -1.34; I2 79%, P<0.001). No data were available concerning the spasticity of other muscles. Static stretching with simple positioning, combined or not with other therapies, was not better than conventional physiotherapy in preventing loss of mobility of shoulder external rotation (MD=3.50, 95% CI -3.45 to 10.45; I2 54.7%, P=0.32), shoulder flexion (MD=-1.20, 95% CI -8.95 to 6.55; I2 0%, P=0.76) or wrist extension (MD=-0.32, 95% CI -6.98 to 5.75; I2 38.5%, P=0.92). No data were available concerning the mobility of other joints. CONCLUSION: This meta-analysis revealed very low-quality evidence that static stretching with positioning orthoses reduces wrist flexion spasticity after stroke as compared with no therapy. Furthermore, we found low-quality evidence that static stretching by simple positioning is not better than conventional physiotherapy for preventing loss of mobility in the shoulder and wrist. Considering the limited number of studies devoted to this issue in post-stroke survivors, further randomized clinical trials are still needed. CLINICAL TRIAL REGISTRATION: PROSPERO (CRD42017078784).
Authors: Maud Pradines; Mouna Ghédira; Blaise Bignami; Jordan Vielotte; Nicolas Bayle; Christina Marciniak; David Burke; Emilie Hutin; Jean-Michel Gracies Journal: Front Neurol Date: 2022-03-14 Impact factor: 4.003