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

TL;DR

This paper reviews whether assistive technologies help manage muscle contractures in stroke patients, finding insufficient evidence to support their effectiveness.

Contribution

A Cochrane Review summarizes evidence on assistive technologies for stroke-related contractures, highlighting the lack of strong clinical evidence.

Findings

Seven studies were analyzed, but evidence on the effectiveness of assistive technologies was very uncertain.

There is insufficient evidence to guide clinical decisions on using assistive technologies for contractures in stroke patients.

Rehabilitation professionals should base decisions on individual patient assessments and preferences.

Abstract

Patients 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.

To summarize the Cochrane Review by Mohammed Meeran et al. and comment on it from a rehabilitation perspective.

The 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.

Seven 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.

There 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.