[Preventive measures for the prophylaxis of contractures in geriatric nursing. A systematic review]

Contractures constitute a health problem in mobility-restricted geriatric patients. Contractures are clinically important due to their impact on functional outcome. Prophylactic interventions seem to be indispensable. We performed a systematic review studying the interventions used to prevent immobility-related contractures in the geriatric long-term care. The efficacy and safety of preventive methods was assessed. Electronic literature searches covered the databases PubMed, PEDro, CINAHL and the Cochrane Library (May 2010). Eligibility criteria for studies were: Investigation of an intervention aimed to prevent contractures, conducted in a geriatric and long-term care setting, inclusion of participants aged>65 years. The primary search focused on RCTs, systematic reviews und meta-analysis published between 1990 and May 2010 in English or German. The included studies were analysed and evaluated by one author while a second author checked the results. Methodological quality was critically evaluated using internationally accepted criteria. Eight studies met the inclusion criteria. Prophylactic interventions comprise mobility-encouraging and position-supportive interventions. Mobility-encouraging interventions aim to prevent contractures and immobility, for example offering range-of-motion exercises. Position-supportive interventions are transformations of motion and position, which are conducted with nurses' support. Due to limited methodological quality of these studies, the efficacy of certain measures remains unclear. Further studies on contracture prophylaxis investigating patient-relevant outcomes, interventions' adverse effects and costs are required.