Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Phys Ther. 2011 Jan;91(1):11-24. doi: 10.2522/ptj.20100265. Epub 2010 Dec 2.
Contractures are a disabling complication of neurological conditions that are commonly managed with stretch.
The purpose of this systematic review was to determine the effectiveness of stretch for the treatment and prevention of contractures. The review is part of a more-detailed Cochrane review. Only the results of the studies including patients with neurological conditions are reported here.
Electronic searches were conducted in June 2010 in the following computerized databases: Cochrane CENTRAL Register of Controlled Trials, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA), MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, SCI-EXPANDED, and Physiotherapy Evidence Database (PEDro).
The review included randomized controlled trials and controlled clinical trials of stretch applied for the purposes of treating or preventing contractures in people with neurological conditions.
Two reviewers independently selected studies, extracted data, and assessed risk of bias. The primary outcome measures were joint mobility (range of motion) and quality of life. Secondary outcome measures were pain, spasticity, activity limitation, and participation restriction. Meta-analyses were conducted using random-effects models.
Twenty-five studies met the inclusion criteria. These studies provide moderate-quality evidence that stretch has a small immediate effect on joint mobility (mean difference=3°, 95% confidence interval [CI]=0° to 5°) and high-quality evidence that stretch has little or no short-term or long-term effects on joint mobility (mean difference=1° and 0°, respectively, 95% CI=0° to 3° and -2° to 2°, respectively). There is little or no effect of stretch on pain, spasticity, and activity limitation.
No studies were retrieved that investigated the effects of stretch for longer than 6 months.
Regular stretch does not produce clinically important changes in joint mobility, pain, spasticity, or activity limitation in people with neurological conditions.
挛缩是一种常见于神经疾病的致残并发症，通常采用拉伸法进行治疗。
本系统评价旨在确定拉伸治疗和预防挛缩的效果。该评价是更为详细的 Cochrane 评价的一部分。此处仅报告包含神经疾病患者的研究结果。
2010 年 6 月，在以下计算机检索数据库中进行了电子检索：Cochrane 对照试验中心注册库、疗效评价文摘数据库（DARE）、卫生技术评估数据库（HTA）、MEDLINE、护理学及相关健康领域文献累积索引（CINAHL）、EMBASE、科学引文索引扩展版（SCI-EXPANDED）和物理治疗证据数据库（PEDro）。
本评价纳入了将拉伸应用于治疗或预防神经疾病患者挛缩的随机对照试验和对照临床试验。
两位评价员独立选择研究、提取数据和评估偏倚风险。主要结局指标是关节活动度（活动范围）和生活质量。次要结局指标为疼痛、痉挛、活动受限和参与受限。采用随机效应模型进行荟萃分析。
25 项研究符合纳入标准。这些研究提供了中等质量证据，表明拉伸对关节活动度有短期的小幅度影响（均数差值=3°，95%置信区间[CI]为 0°至 5°），而高质量证据表明拉伸对短期或长期关节活动度几乎没有或没有影响（均数差值分别为 1°和 0°，95%CI 分别为 0°至 3°和-2°至 2°）。拉伸对疼痛、痉挛和活动受限几乎没有或没有影响。
没有检索到研究拉伸对神经疾病患者的影响超过 6 个月。
常规拉伸对神经疾病患者的关节活动度、疼痛、痉挛或活动受限没有产生临床重要的变化。
