Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis

Ana Paula Salazar; Camila Pinto; Joao Victor Ruschel Mossi; Bruno Figueiro; Janice Luisa Lukrafka; Aline Souza Pagnussat

doi:10.1016/j.rehab.2018.11.004

Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis

Ann Phys Rehabil Med. 2019 Jul;62(4):274-282. doi: 10.1016/j.rehab.2018.11.004. Epub 2018 Dec 22.

Authors

Ana Paula Salazar¹, Camila Pinto¹, Joao Victor Ruschel Mossi², Bruno Figueiro², Janice Luisa Lukrafka³, Aline Souza Pagnussat⁴

Affiliations

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.

PMID: 30582986
DOI: 10.1016/j.rehab.2018.11.004

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).

Keywords: Muscle spasticity; Muscle stretching exercises; Physical therapy modalities; Physiotherapy; Range of motion; Rehabilitation.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Arm
Humans
Muscle Spasticity / therapy*
Muscle Stretching Exercises* / methods
Recovery of Function
Stroke / complications*
Stroke Rehabilitation