Passive range of motion exercises (v no intervention) on joint mobility in people with SCI | SCI Physiotherapy Clinical Practice Guidelines

	Passive range of motion exercises (v no intervention) on joint mobility in people with SCI
P	People with SCI	Evidence recommendation No evidence recommendation Reason: No recommendation due to insufficient or inconclusive evidence.		Weak opinion statement FOR Passive range of motion exercises (v no intervention) on joint mobility in people with SCI
I	Passive range of motion exercises
C	No intervention	Consensus-based opinion statement Weak for (100%)
O	Joint mobility	Consensus-based opinion statement Weak for (100%)
	SUMMARY	1 RCT		Mean difference (95% CI): Joint mobility in degrees 4 (2 to 6) Favours passive m ovements
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Serious	Imprecision No serious	Indirectness Serious	Publication bias Serious

PASSIVE RANGE OF MOTION EXERCISES: 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

PASSIVE RANGE OF MOTION EXERCISES ON JOINT MOBILITY: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
HARVEY 2009	Passive Movements V No Intervention	10 minutes of ankle passive movements, 10 x per week for 6 months	C3 -C7 tetraplegia	20/20	Modified Ashworth	Some Concerns of Risk of Bias PEDro = 8/10

The Australian and NZ SCI Physiotherapy guideline committee recommends passive range of motion exercises to prevent and treat loss of joint mobility in people with spinal cord injury.

This is a consensus-based opinion statement supported by the opinions of the experts even though there are randomised controlled trials related to this topic. The results of these randomised controlled trials are either contradictory or inconclusive preventing an evidence recommendation. The guideline states:

Passive range of motion exercises may be provided to prevent and treat loss of joint mobility in people with SCI.

This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, personal experience, equity, accessibility, feasibility and personal experience. The results of the two randomised controlled trials were also taken into consideration.

This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend passive range of motion exercises to prevent and treat loss of joint mobility based on opinion.

To learn more about the this intervention go to the research evidence.

Harvey L, Herbert R, Glinsky J, Moseley A and Bowden J. Effects of six months of regular passive movements on ankle joint mobility in people with spinal cord injury: A randomised controlled trial. Spinal Cord 2009. 47:62-68.