PMID- 36691685
OWN - NLM
STAT- MEDLINE
DCOM- 20231102
LR  - 20240210
IS  - 1941-0921 (Electronic)
IS  - 1941-7381 (Print)
IS  - 1941-0921 (Linking)
VI  - 15
IP  - 6
DP  - 2023 Nov-Dec
TI  - Stretching, Bracing, and Devices for the Treatment of Osteoarthritis-Associated 
      Joint Contractures in Nonoperated Joints: A Systematic Review and Meta-Analysis.
PG  - 867-877
LID - 10.1177/19417381221147281 [doi]
AB  - CONTEXT: Many patients with osteoarthritis (OA) develop range of motion (ROM) 
      restrictions in their affected joints (contractures), associated with worse 
      outcomes and rising healthcare costs. Effective treatment guidance for lost ROM 
      in OA-affected joints is lacking. OBJECTIVE: A systematic review and 
      meta-analysis evaluating the effectiveness of stretching and/or bracing protocols 
      on native (nonoperated) joint ROM in the setting of radiographically diagnosed 
      OA. DATA SOURCES: Seven databases, English-language. STUDY SELECTION: Studies 
      including participants with radiographically diagnosed OA in any native joint 
      evaluating the effect of stretching or bracing on ROM. STUDY DESIGN: Systematic 
      review and meta-analysis. LEVEL OF EVIDENCE: Level 2. DATA EXTRACTION: Two 
      reviewers independently screened articles for inclusion and assessed risk of bias 
      in included trials. Primary outcomes were ROM, pain, and adverse events (AEs). 
      RESULTS: We identified 6284 articles. A total of 9 randomized controlled trials, 
      all evaluating the knee, met eligibility criteria. For stretching, 3 pooled 
      studies reported total ROM, which improved by mean difference (MD) of 9.3 degrees  (95% 
      CI 5.0 degrees ,13.5 degrees ) versus controls. Two pooled studies showed improved knee flexion 
      ROM (MD 10.8 degrees  [7.3 degrees ,14.2 degrees ]) versus controls. Five studies were pooled for knee 
      extension with mean improvement 9.1 degrees  [3.4 degrees ,14.8 degrees ] versus controls. Seven pooled 
      studies showed reduced pain (standardized MD 1.9 [1.2,2.6]). One study reported 
      improved knee extension of 3.7 degrees  [2.9 degrees ,4.5 degrees ] with use of a device. No studies used 
      orthoses. One study reported on AEs, with none noted. Performance bias was 
      present in all included studies, and only 3 studies clearly reported blinding of 
      outcome assessors. Strength of evidence for primary outcomes was considered 
      moderate. CONCLUSION: There was moderate-quality evidence that stretching is an 
      effective strategy for improving knee total, flexion and extension ROM, and pain. 
      Our findings suggest that stretching to regain joint ROM in OA is not futile and 
      that stretching appears to be an appropriate conservative intervention to improve 
      patient outcomes as part of a comprehensive knee OA treatment plan before 
      arthroplasty.
FAU - Campbell, T Mark
AU  - Campbell TM
AD  - Department of Physical Medicine and Rehabilitation, Elisabeth Bruyere Hospital, 
      Ottawa, Ontario, Canada.
AD  - Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
AD  - Bone and Joint Laboratory, Ottawa Hospital Research Institute, Ottawa, Ontario, 
      Canada.
AD  - The Ottawa Hospital, Department of Medicine, Ottawa, Ontario, Canada.
AD  - University of Ottawa, Department of Cellular and Molecular Medicine, Ottawa, 
      Ontario, Canada.
FAU - Westby, Marie
AU  - Westby M
AD  - Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, 
      Vancouver, British Columbia, Canada.
FAU - Ghogomu, Elizabeth Tanjong
AU  - Ghogomu ET
AD  - Bruyere Research Institute, Ottawa, Ontario, Canada.
FAU - Fournier, John
AU  - Fournier J
AD  - University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada.
FAU - Ghaedi, Bahareh Bahram
AU  - Ghaedi BB
AD  - Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
FAU - Welch, Vivian
AU  - Welch V
AD  - University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada.
AD  - School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, 
      Canada.
LA  - eng
GR  - EP-D-18-001/EPA/EPA/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20230123
PL  - United States
TA  - Sports Health
JT  - Sports health
JID - 101518422
SB  - IM
MH  - Humans
MH  - *Osteoarthritis, Knee/etiology
MH  - Braces
MH  - Exercise Therapy/adverse effects
MH  - *Contracture/etiology
MH  - Pain/etiology
PMC - PMC10606959
OTO - NOTNLM
OT  - meta-analysis
OT  - osteoarthritis
OT  - range of motion
OT  - stretching
OT  - systematic review
COIS- The authors report no potential conflicts of interest in the development and 
      publication of this article.
EDAT- 2023/01/25 06:00
MHDA- 2023/01/25 06:01
PMCR- 2024/01/23
CRDT- 2023/01/24 01:53
PHST- 2023/01/25 06:01 [medline]
PHST- 2023/01/25 06:00 [pubmed]
PHST- 2023/01/24 01:53 [entrez]
PHST- 2024/01/23 00:00 [pmc-release]
AID - 10.1177_19417381221147281 [pii]
AID - 10.1177/19417381221147281 [doi]
PST - ppublish
SO  - Sports Health. 2023 Nov-Dec;15(6):867-877. doi: 10.1177/19417381221147281. Epub 
      2023 Jan 23.