Passive movements for contractures

Contractures, a common complication following immobility, lead to restricted joint range of motion. Passive movements (PMs) are widely used for the treatment and prevention of contractures; however, it is not clear whether they are effective

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202018 Registration no: SBU 2020/142

Question

What systematic reviews are there on passive movements for contractures?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias
Included studies Population/Intervention Outcome
Prabhu, et. al. 2013
2 randomised studies, a total of 122 participants with neurological conditions comparing passive movements versus no passive movements.
Both studies had a low risk of bias.		 Participants with existing contractures or those at risk of developing contractures. Participants of either gender and of any age were included. Participants were included regardless of sensory or motor impairments and were separated according to their broad diagnostic groups.
Both studies investigated the effects of PMs in persons with neurological conditions. One study included people with spinal cord injury, and the other elderly people with paratonia.		 Effect: Joint mobility, including measures of active or passive range of motion with or without standardised torques. Units of measure were expressed in degrees (degree per unit of torque or centimetre). Unidirectional and bidirectional range of motion measurements were included; and
Adverse effects: None reported. The aim was to include joint subluxations or dislocations, heterotopic ossification, autonomic dysreflexia (an exaggerated response of the sympathetic nervous system typically seen in people with spinal cord injury), fractures and muscle tears.
Authors' conclusion: “It is not clear whether passive movements are effective for the treatment and prevention of contractures.”
“The GRADE level of evidence showing the effects of Passive Movements on joint mobility, spasticity and pain is very low, primarily because of the paucity of studies in the area. Medium- and long-term effects of PMs on any outcome have not been investigated.”

References

  1. Prabhu RKR, Swaminathan N, Harvey LA.(2013) Passive movements for the treatment and prevention of contractures. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD009331. DOI: 10.1002/14651858.CD009331.pub2.

Literature search

PubMed via NLM 200319 
Muscle stretching for prevention of contracture
The search result, usually found at the end of the documentation, forms the list of abstracts; [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [MeSH:NoExp] = Does not include terms found below this term in the MeSH hierarchy; [MAJR] = MeSH Major Topic; [TIAB] = Title or abstract; [TI] = Title; [AU] = Author; [TW] = Text Word; Systematic[SB] = Filter for retrieving systematic reviews; * = Truncation
Search terms Items found
Population:
1. Muscle Stretching Exercises[majr] OR Resistance Training[majr] OR Motion Therapy, Continuous Passive[mesh] OR Musculoskeletal Manipulations[majr] OR (passive[tiab] AND movement[tiab]) OR (passive[tiab] AND motion[tiab]) OR (CPM[tiab] AND therapy[tiab]) OR stretch*[tiab] OR lenght*[tiab] 102461
Intervention:
2. Contracture[mesh] OR contracture*[tiab] OR Muscle Spasticity[mesh] OR Muscle Hypertonia[mesh] OR Muscle Rigidity[mesh] OR Elasticity[mesh] OR Range of Motion, Articular[mesh] OR "Range of motion"[tiab] OR (Joint*[tiab] OR muscle*[tiab] OR limb[tiab]) AND (mobili*[tiab] OR movement*[tiab] OR spastic*[tiab] OR rigid*[tiab] OR elastic*[tiab] OR stiff*[tiab] OR extensib*[tiab] OR flexib*[tiab] OR shorten*[tiab]) 167125
3. Prevent*[tiab] OR profyla*[tiab] 1406572
Combined sets:
4. 1 AND 2 AND 3 848
Study types:
5. "Meta-Analysis" [Publication Type] OR  "Meta-Analysis as Topic"[Mesh] "Systematic Reviews as Topic"[Mesh] OR  "Systematic Review" [Publication Type] OR Systematic[sb] OR “systematic review”[tiab] OR “meta analysis”[tiab] OR metaanalysis[tiab] 252685
Final 4 AND 5 32

 

Cochrane Library via Wiley 200319 
Muscle stretching for prevention of contracture
The search result, usually found at the end of the documentation, forms the list of abstracts; au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; CENTRAL = Cochrane Central Register of Controlled Trials, “trials”; CRM = Method Studies; DARE = Database Abstracts of Reviews of Effects, “other reviews”; EED = Economic Evaluations; HTA = Health Technology Assessments
Search terms Items found
Population:
1. [mh "Muscle Stretching Exercises"] OR [mh "Resistance Training"] OR [mh "Motion Therapy, Continuous Passive"] OR [mh "Musculoskeletal Manipulations"] OR (passive:ti,ab,kw AND movement:ti,ab,kw) OR (passive:ti,ab,kw AND motion:ti,ab,kw) OR (CPM:ti,ab,kw AND therapy:ti,ab,kw) OR stretch*:ti,ab,kw OR lenght*:ti,ab,kw 14201
Intervention:
2. [mh "Contracture"] OR contracture*:ti,ab,kw OR [mh "Muscle Spasticity"] OR [mh "Muscle Hypertonia"] OR [mh "Muscle Rigidity"] OR [mh "Elasticity"] OR [mh "Range of Motion, Articular"] OR "Range of motion":ti,ab,kw OR (Joint*:ti,ab,kw OR muscle*:ti,ab,kw OR limb:ti,ab,kw) AND (mobili*:ti,ab,kw OR movement*:ti,ab,kw OR spastic*:ti,ab,kw OR rigid*:ti,ab,kw OR elastic*:ti,ab,kw OR stiff*:ti,ab,kw OR extensib*:ti,ab,kw OR flexib*:ti,ab,kw OR shorten*:ti,ab,kw) 105178
3. Prevent*:ti,ab,kw OR profyla*:ti,ab,kw 216304
Combined sets:
4. 1 AND 2 AND 3 978
Limits:
5. Cochrane reviews  
Final 4 AND 5 29

 

Embase via embase.com 200319 
Muscle stretching for prevention of contracture
/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. 'stretching exercise'/mj OR 'resistance training'/mj OR 'movement therapy'/mj OR 'musculoskeletal manipulation'/mj OR (passive:ti,ab AND movement:ti,ab) OR (passive:ti,ab AND motion:ti,ab) OR (CPM:ti,ab AND therapy:ti,ab) OR stretch*:ti,ab OR lenght*:ti,ab 104148
Intervention:
2. 'contracture'/exp OR contracture*:ti,ab OR 'spasticity'/exp OR 'muscle hypertonia'/exp OR 'muscle rigidity'/exp OR 'joint characteristics and functions'/exp OR "Range of motion":ti,ab OR (Joint*:ti,ab OR muscle*:ti,ab OR limb:ti,ab) AND (mobili*:ti,ab OR movement*:ti,ab OR spastic*:ti,ab OR rigid*:ti,ab OR elastic*:ti,ab OR stiff*:ti,ab OR extensib*:ti,ab OR flexib*:ti,ab OR shorten*:ti,ab) 202584
3. Prevent*:ti,ab OR profyla*:ti,ab 1813235
Combined sets:
4. 1 AND 2 AND 3 1101
Study types:
5. 'systematic review'/exp OR 'cochrane library'/exp OR 'meta analysis'/exp OR ((systematic* NEAR/3 review) OR ‘meta analy*’ OR metaanaly*):ab,ti,kw 432173
Final 4 AND 5 47

 

Cinahl via ebsco.com 200319 
Muscle stretching for prevention of contracture
The search result, usually found at the end of the documentation, forms the list of abstracts; AB = Abstract; AU = Author; DE = Term from the thesaurus; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the 
database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. (MM "Resistance Training") OR (MH "Stretching") OR (MH "Flexion") OR (MH "Extension") OR (MH "Bending") OR (MH "Motion Therapy, Continuous Passive") OR TI ((passive AND movement) OR (passive AND motion) OR (CPM AND therapy) OR stretch* OR lenght*) OR AB ((passive AND movement) OR (passive AND motion) OR (CPM AND therapy) OR stretch* OR lenght*) 27895
Intervention:
2. (MH "Contracture+") OR (MH "Muscle Spasticity") OR (MH "Muscle Hypertonia+") OR (MH "Range of Motion") OR TI (contracture* OR "Range of motion" OR (Joint* OR muscle* OR limb) AND (mobili* OR movement* OR spastic* OR rigid* OR elastic* OR stiff* OR extensib* OR flexib* OR shorten*)) OR AB (contracture* OR "Range of motion" OR (Joint* OR muscle* OR limb) AND (mobili* OR movement* OR spastic* OR rigid* OR elastic* OR stiff* OR extensib* OR flexib* OR shorten*)) 67515
3. TI (Prevent* OR profyla*) OR AB (Prevent* OR profyla*) 381240
Combined sets:
4. 1 AND 2 AND 3 705
Study types:
5. (MH ”systematic review”) OR (MH ”cochrane library”) OR (MH ”meta analysis”) 124138
Final 4 AND 5 49
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