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Effectiveness of Stretch Interventions for Children With Neuromuscular Disabilities: Evidence-Based Recommendations
Jason Craig1, Courtney Hilderman, Geoffrey Wilson
1Department of Physical Therapy, Queen Alexandra Centre for Children's Health, Island Health, Victoria, British Columbia, Canada (Mr Craig, Ms Misovic, and Mr Wilson); and Department of Physical Therapy, BC Centre for Ability, and University of British Columbia, Vancouver, Canada (Ms Hilderman).
Insights
Casting, orthoses, and supported standing programs show limited benefits for children with neuromuscular disabilities. Evidence is inconclusive regarding stretching interventions for contractures, activity, or participation.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Disorders
- Evidence-Based Practice
Background:
- Children with neuromuscular disabilities often experience challenges with body functions, structures, activity, and participation.
- Interventions like casting, orthoses, stretching, and supported standing are commonly used.
- Determining the effectiveness of these interventions is crucial for optimizing care.
Purpose of the Study:
- To systematically review the evidence on the effectiveness of casting, orthoses, stretching, and supported standing programs.
- To assess the impact of these interventions on body functions, structures, activity, and participation in children with neuromuscular disabilities.
Main Methods:
- A systematic review of Level 1 and 2 studies was performed.
- Six electronic databases were searched for relevant research.
- Interventions were analyzed using the International Classification of Function and evaluated using established grading systems.
Main Results:
- Low-grade evidence suggests casting may temporarily increase ankle range of motion.
- Orthoses show potential for improving gait parameters during use.
- Supported standing programs may enhance bone mineral density.
Conclusions:
- Limited evidence supports stretch interventions for improving body functions and structures.
- Evidence is inconclusive on the efficacy of stretching for preventing contractures or improving activity/participation.
Purpose:
To determine whether casting, orthoses, stretching, or supported standing programs are effective in improving or maintaining body functions and structures, activity, or participation in children with neuromuscular disabilities.
Methods:
A systematic review was conducted using 6 electronic databases to identify Level 1 and 2 studies investigating stretch interventions for children aged 0 to 19 years with neuromuscular disabilities. Interventions were coded using the International Classification of Function and rated with Grading of Recommendation Assessment, Development and Evaluation, the Oxford Levels of Evidence, and the Evidence Alert Traffic Light System.
Results:
Sixteen studies evaluated the effectiveness of stretch interventions. Low-grade evidence supports casting temporarily increasing ankle range of motion, orthoses improving gait parameters while they are worn, and supported standing programs improving bone mineral density.
Conclusion:
There is limited evidence suggesting stretch interventions benefit body functions and structures. There is inconclusive evidence to support or refute stretching interventions for preventing contractures or impacting a child's activity or participation.
Trial Registration:
Prospero CRD42014013807.
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