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

	Passive range of motion exercises (v no intervention) on spasticity 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 AGAINST Passive range of motion exercises should not be provided to treat spasticity in people with SCI.
I	Passive range of motion exercises
C	No intervention	Consensus-based opinion statement Weak against (100%)
O	Spasticity	Consensus-based opinion statement Weak against (100%)
	SUMMARY	2 RCTs		Consider studies independently. Unable to pool I2 = 90%
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Very serious	Imprecision Very serious	Indirectness Very serious	Publication bias Serious

PASSIVE RANGE OF MOTION EXERCISES ON SPASTICITY: 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 SPASTICITY: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
CHANG 2013	Continuous Passive Motion (CPM) V No intervention	CPM of the ankle joint for 1 hour per day, 5 x per week for 4 weeks	C5-T12 SCI	7/7	Modified Ashworth	Some Concerns of Risk of Bias PEDro = 5/10
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 against passive movements to improve treat spasticity in people with SCI. This is a consensus-based opinion statement supported by the opinions of the experts and two randomised controlled trials related to this topic. The guideline states:

Passive range of motion exercises should not be administered to treat spasticity in people with SCI.

This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, equity, accessibility, feasibility and personal experience.

This is a consensus-based opinion statement. Opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a weak statement which means that the guideline panel is confident they can probably recommend against passive movements to treat spasticity based on opinion. To learn more about the this intervention go to the research summary.

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.
Chang Y-J, Liang J-N, Hsu M-J, et al. Effects of continuous passive motion on reversing the adapted spinal circuit in humans with chronic spinal cord injury. Archives of physical medicine and rehabilitation 2013; 94: 822-828.