Four weeks of daily stretch has little or no effect on wrist contracture after stroke: a randomised controlled trial

QuestionsIn adults undergoing rehabilitation after stroke, does 30 minutes of daily stretch of the wrist and finger flexors for four weeks prevent or reverse contracture, decrease pain, or improve upper-limb activity? Are any gains maintained one week and five weeks after the cessation of stretching?DesignRandomised controlled trial with concealed randomisation, assessor blinding, and intention-to-treat analysis.Participants40 adults undergoing rehabilitation after stroke or stroke-like brain injury, who were unable to actively extend the affected wrist.InterventionBoth groups received routine upper-limb retraining five days a week. In addition, the experimental group received 30 minutes daily stretch of the wrist and finger flexors five days a week for four weeks.Outcome measuresThe primary outcome was contracture, measured as torque-controlled passive wrist extension with the fingers extended. Secondary outcomes were pain at rest measured on a 10-cm visual analogue scale, and upper-limb activity measured using the Motor Assessment Scale. Outcomes were collected at baseline, post-intervention, and one and five weeks after cessation of intervention.ResultsThe mean effect on passive range of wrist extension was 5.1 degrees (95% CI –0.9 to 11.1) after 4 weeks of daily stretch, 4.1 degrees (95% CI –4.0 to 12.3) after a week of no stretch, and 3.5 degrees (95% CI –4.6 to 11.7) after a further four weeks.ConclusionThese data suggest that four weeks of regular stretching has little or no effect on wrist contracture after stroke. However the estimate of the size of this effect is not sufficiently precise to rule out the possibility of a marginally worthwhile effect. The stretch had no significant effect on upper-limb pain, and did not result in significantly improved upper-limb activity.