Are Assistive Technologies Effective in the Management of Contractures in People with Stroke? - A Cochrane Review Summary with Commentary.

BackgroundPatients who have had a stroke are at risk of contractures, a shortening of muscles and other soft tissues. Muscle stretching, manually or delivered by other means, is a common strategy to manage contractures following stroke. A Cochrane Review by Mohammed Meeran et al. has investigated the effectiveness of assistive technology defined as a mechanical, electrical, or electromechanical device used to stretch or lengthen a muscle statically, dynamically, or cyclically for preventing or reducing contractures.ObjectiveTo summarize the Cochrane Review by Mohammed Meeran et al. and comment on it from a rehabilitation perspective.MethodsThe Cochrane Review authors identified randomised controlled studies (RCTs) which investigated the use of electrical, mechanical, or electromechanical devices to manage contractures in adults with stroke. RCTs had to compare these assistive technologies with no treatment, routine therapy, or another assistive technology. Passive range of motion (PROM) was the primary outcome.ResultsSeven studies (294 participants) were included. Data from five studies (252 participants) comparing assistive technologies with routine care were meta-analyzed. The evidence was very uncertain about the effect of assistive technology on PROM, adverse events and other outcomes.ConclusionsThere is insufficient evidence to support clinical decisions about the effectiveness of assistive technology in the management of contractures in people with stroke. Rehabilitation professionals should select strategies for management of contractures in patients with stroke based on an expert assessment of a patient's individual needs and preferences, and ensure regular re-assessment. High quality research is necessary in this field.