Steffen T M, Mollinger L A
Director of Physical Therapy, Concordia University, Mequon, WI 53092, USA.
Phys Ther. 1995 Oct;75(10):886-95; discussion 895-7. doi: 10.1093/ptj/75.10.886.
The purpose of this study was to do a pilot test of the effectiveness of prolonged stretch (use of splint) in reducing knee flexion contractures more than a traditional program of passive range of motion (PROM) in a group of nursing home residents.
The subjects were 28 nursing home residents with 10 degrees or more of knee flexion contracture bilaterally. Eighteen subjects completed the study.
Data were collected prior to the initiation of the intervention and at monthly intervals during the 6 months of treatment. Repeated measurements were made of hip, knee, and ankle range of motion (ROM); the torque required to maintain passive impairment. knee extension; knee pain; several indicators of function; and cognitive impairment. Both legs of each subject received PROM and manual stretching twice a week; in addition, one leg was given a prolonged stretch (use of a splint) five times a week.
There were no differences in knee ROM between the side that received prolonged stretching and the side that received only PROM and manual stretching at the beginning of the study. No differences in ROM or torque measurements existed between the side that received prolonged stretching and the side that received only PROM and manual stretching at any interval, nor in ROM or torque over time for either side. Because of the low statistical power of the study, the results should be viewed with caution.
Physical therapists need to question whether prolonged stretch for nursing home residents with knee flexion contractures greater than 10 degrees is of any greater benefit than PROM and manual stretching. Investigations of other treatment protocols and treatment doses are needed, including work in the area of prevention of knee flexion contractures. For the pilot group of nursing home residents studied, gains in knee extension did not occur with the use of prolonged stretch for 3 hours a day, 5 days per week. [Steffen TM, Mollinger LA. Low-load, prolonged stretch in the treatment of knee flexion contractures in nursing home residents.
本研究旨在进行一项初步试验，以探究在一组疗养院居民中，与传统的被动活动度训练（PROM）方案相比，长时间伸展（使用夹板）在减少膝关节屈曲挛缩方面是否更有效。
受试者为28名双侧膝关节屈曲挛缩达10度或以上的疗养院居民。18名受试者完成了研究。
在干预开始前以及治疗的6个月期间每月收集数据。对髋、膝和踝关节活动度（ROM）、维持被动损伤所需的扭矩、膝关节伸展、膝关节疼痛、若干功能指标以及认知障碍进行重复测量。每位受试者的双腿每周接受两次PROM和手法拉伸；此外，一条腿每周接受五次长时间伸展（使用夹板）。
在研究开始时，接受长时间伸展的一侧与仅接受PROM和手法拉伸的一侧在膝关节ROM方面没有差异。在任何时间点，接受长时间伸展的一侧与仅接受PROM和手法拉伸的一侧在ROM或扭矩测量方面均无差异，两侧的ROM或扭矩随时间也无差异。由于该研究的统计效力较低，应谨慎看待结果。
物理治疗师需要质疑，对于膝关节屈曲挛缩大于10度的疗养院居民，长时间伸展是否比PROM和手法拉伸更有益。需要对其他治疗方案和治疗剂量进行研究，包括在预防膝关节屈曲挛缩方面的工作。对于所研究的疗养院居民试点组，每周5天、每天3小时使用长时间伸展并未使膝关节伸展得到改善。[斯特芬TM，莫林格LA。低负荷长时间伸展治疗疗养院居民膝关节屈曲挛缩。
