A pilot randomized controlled trial of a daily muscle stretch regime to prevent contractures in the arm after stroke

Objective: To evaluate the feasibility and effects of daily stretch positioning for prevention of contractures in stroke patients without arm function. Design: Randomized controlled pilot study. Setting: Stroke rehabilitation ward, UK. Subjects: Twenty-five subjects drawn from an initial pool of 126 presenting with loss of arm function, all within four weeks of stroke. Interventions: In addition to usual care, subjects in the experimental group (n = 13) were prescribed two 30-min stretches for wrist and finger flexors and two 30-min stretches targeting shoulder adductors and internal rotators, per day for up to 12 weeks post stroke. Stretches were carried out by therapists and nursing staff. Main measures: Passive range of wrist extension and shoulder external rotation to standard force or to pain at four, eight and twelve weeks after stroke. Results: Compliance was variable. Frequency of positioning was fair from four to eight weeks post stroke but declined after that. Mean (SD) frequency of stretch positions completed between four and eight weeks was 36.5 (13.0) for the wrist, 31.2 (14.1) for the shoulder, out of 56 prescribed. There were no significant effects of treatment. By eight weeks post stroke the mean range of wrist extension and shoulder external rotation lost on the affected side in both groups was similar to 30 degrees. Conclusions: The stretch treatment was not well tolerated over many weeks. Statistical power was low due to the large degree of variability of range of motion and small sample size. The regime tested cannot be recommended as a workable treatment to prevent contractures.