Schaidt D, Falkenberg S, Heller P, Zalewski KR; Concordia University Wisconsin, Mequon, WI. Diana.Schaidt@cuw.edu.

PURPOSE: The purposes of this project were: 1) to conduct an evidence-based review of the literature using the modified American Academy of Developmental Medicine and Cerebral Palsy (AACPDM) methodology to examine the effects of passive stretch on range of motion (ROM), spasticity and functional outcomes in adults with central nervous system (CNS) dysfunctions, and 2) to apply the results of the review to physical therapy clinical practice. FOUNDATION: The rationale behind the AACPDM methodology is to provide a systematic method for evaluating the quality of the literature used for informed clinical decision making. Applying passive stretch to tissues is a commonly used treatment performed by physical therapy professionals to improve impairments in ROM or spasticity, with the goal to improve functional abilities (ambulation, self care). Continued use of this treatment requires supporting evidence from the literature. DESCRIPTION: The literature search was conducted using the PubMed and CINAHL databases. Studies were included if participants were at least 16 years old, had an acquired CNS dysfunction, and had treatment where a passive stretch was applied for at least 30 seconds. Only studies evaluating effect in the lower extremities were included. The ten articles that met these inclusion criteria were reviewed and summarized for this clinical decision using the modified AACPDM approach. OBSERVATIONS: Of the articles reviewed, one was a randomized controlled study, three were non-randomized with two groups, five were pre-post treatment studies, and one was a patient survey. Eight articles had threats to internal validity. Statistically significant results for passive stretch were observed at the impairment level only. These included improvements in ROM, torque relaxation, speed of relaxation, resistance due to spasticity, and a scale of perceived effect of stretching on spasticity. No comparative statistics were completed on functional level data, but improvements were reported. All outcome data were subjectively judged to be clinically important. No negative effects of stretching were ascertained. CONCLUSIONS: The modified AACPDM methodology seems to be a meaningful way for clinicians to critically evaluate literature. The literature provides only weak evidence supporting the use of passive stretching the improve ROM and reduce spasticity in the lower extremities of adults with CNS dysfunctions. Existing research in this area does not contain a sufficient number of randomized controlled trials. Future research with higher quality data is needed for a more confident answer to this research question. FUNDING SOURCE: None.

Copyright 2004 by the American Physical Therapy Association

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