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Weak For Recommendation
Long duration stretch may be provided to prevent and treat loss of joint mobility in people with SCI.
Long duration stretch (v no intervention) on joint mobility in people with SCI
P
People with SCI
Evidence recommendation
Weak for (95%)
Weak evidence recommendation FOR
Long duration stretch may be provided to prevent and treat loss of joint mobility in people with SCI.
I
Long duration stretch
C
No intervention
Consensus-based opinion statement
No opinion statements
O
Joint mobility
SUMMARY
3 RCTs
(see references)
Mean difference (95% CI): Joint mobility in degrees
2 (-1 to 5) Favours long duration stretch
Favours stretch
GRADE
Very low certainty
⨁◯◯◯
Risk of bias
Serious
Inconsistency
Serious
Imprecision
No serious
Indirectness
Serious
Publication bias
Serious
LONG DURATION STRETCH ON JOINT MOBILITY: GRADE Evidence to Decision
PROBLEM
No
Probably no
Probably yes
Yes
Don't know
DESIRABLE EFFECTS
Trivial
Small
Moderate
Large
Don't know
UNDESIRABLE EFFECTS
Large
Moderate
Small
Trivial
Don't know
CERTAINTY OF EVIDENCE
Very low
Low
Moderate
High
No included studies
HOW MUCH PEOPLE VALUE THE MAIN OUTCOME
Important uncertainty or variability
Possibly important uncertainty or variability
Probably no important uncertainty or variability
No important uncertainty or variability
BALANCE OF EFFECTS
Favours the Control
Probably favours the Control
Does not favour either the intervention (I) or the comparison (C)
Probably favours the I
Favours the I
Don't know
RESOURCES REQUIRED
Large costs
Moderate costs
Negligible costs and savings
Moderate savings
Large savings
Don't know
CERTAINTY OF EVIDENCE OF REQUIRED RESOURCES
Very low
Low
Moderate
High
No included studies
COST EFFECTIVENESS
Favours the comparison
Probably favours the comparison
Does not favour either the intervention or the comparison
Probably favours the intervention
Favours the intervention
No included studies
EQUITY
Reduced
Probably reduced
Probably no impact
Probably increased
Increased
Don't know
ACCEPTABILITY
No
Probably no
Probably yes
Yes
Don't know
FEASIBILITY
No
Probably no
Probably yes
Yes
Don't know
LONG DURATION STRETCH ON JOINT MOBILITY: Randomised Controlled Trial Details
STUDY
COMPARISON
DOSAGE/DETAILS
PARTICIPANTS
N (Rx/C)
OUTCOME
ROB 2
PEDRo
BEN 2005
Long duration stretch
V
No intervention
30 minutes, 3 x per week for 12 weeks of standing on TT
People with SCI and LL paralysis
20/20
Ankle mobility (degrees)
Some Concerns of
Risk of Bias
PEDro = 8/10
HARVEY 2000
Long duration stretch
V
No intervention
30 mins, 5 x per week for 4 weeks
People with SCI and LL paralysis
7/7
Ankle mobility (degrees)
Some Concerns of
Risk of Bias
PEDro = 8/10
HARVEY 2003
Long duration stretch
V
No intervention
30 mins, 5 x per week for 4 weeks
People with SCI and LL paralysis
16/16
Joint mobility/Hamstring length (degrees)
Some Concerns of
Risk of Bias
PEDro = 7/10
The Australian and NZ SCI Physiotherapy guideline committee recommends long duration stretch to prevent and treat loss of joint mobility in people with SCI. This is an evidence recommendation supported by the results of 3 randomised controlled trials. The guideline states:
Long duration stretch may be provided to prevent and treat loss of joint mobility in people with SCI.
This recommendation was formed by considering the results of three randomised controlled trials alongside other factors. The trial results indicate that long duration stretch is better than no long duration stretch to improve joint mobility. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.
This is an evidence-based recommendation. Evidence-based recommendations are more robust than consensus-based opinion statements. They can be strong or weak. This is a weak evidence-based recommendation which means the guideline panel is confident that they can probably recommend long duration stretch to prevent and treat loss of joint mobility in people with SCI based on evidence. To learn more about this recommendation go to the research summary.
Ben M, Harvey L, Denis S, et al. Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries? Australian journal of physiotherapy 2005;51:251.
Harvey LA, Batty J, Crosbie J, et al. A randomized trial assessing the effects of 4 weeks of daily stretching on ankle mobility in patients with spinal cord injuries. Arch Phys Med Rehabil 2000; 81:1340-1347.
Harvey LA, Byak AJ, Ostrovskaya M, et al. Randomised trial of the effects of four weeks of daily stretch on extensibility of hamstring muscles in peoplewith spinal cord injuries. Aust J Physiotherapy 2003; 49:176-181.
