Interventions for increasing ankle range of motion in patients with neuromuscula

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Cochrane Database Syst Rev. 2010 Feb 17;2:CD006973.

Interventions for increasing ankle range of motion in patients with

neuromuscular disease.

Rose KJ, Burns J, Wheeler DM, North KN.

Institute of Neuroscience and Muscle Research, The Children's Hospital at

Westmead, Discipline of Paediatrics and Child Health, Faculty of Medicine,

University of Sydney, Sydney, Australia.

BACKGROUND: Reduced ankle dorsiflexion range of motion, or ankle equinus, is a

common and disabling problem for patients with neuromuscular disease. Clinicians

devote considerable time and resources implementing interventions to correct

this problem although few of these interventions have been subject to rigorous

empirical investigation.

OBJECTIVES: To assess the effect of interventions to reduce or resolve ankle

equinus in people with neuromuscular disease.

SEARCH STRATEGY: We searched the Cochrane Neuromuscular Disease Group Trials

Specialized Register (August 2009), Cochrane Central Register of Controlled

Trials (The Cochrane Library Issue 3, 2009), MEDLINE (1966 to August 2009),

EMBASE (1980 to August 2009), CINAHL 1982 to August 2009), AMED (1985 to August

2009) and The Physiotherapy Evidence Database (PEDro) (1929 to August 2009). We

searched the reference lists of identified articles and also contacted known

experts in the field to identify additional or unpublished data.

SELECTION CRITERIA: Randomised controlled trials evaluating interventions for

increasing ankle dorsiflexion range of motion in neuromuscular disease. Outcomes

included ankle dorsiflexion range of motion, functional improvement, foot

alignment, foot and ankle muscle strength, health-related quality of life,

satisfaction with the intervention and adverse events.

DATA COLLECTION AND ANALYSIS: Two authors independently selected papers,

assessed trial quality and extracted data.

MAIN RESULTS: Four studies involving 149 participants met inclusion criteria for

this review. Two studies assessed the effect of night splinting in a total of 26

children and adults with Charcot-Marie-Tooth disease type 1A. There were no

statistically or clinically significant differences between wearing a night

splint and not wearing a night splint. One study assessed the efficacy of

prednisone treatment in 103 boys with Duchenne muscular dystrophy. While a daily

dose of prednisone at 0.75 mg/kg/day resulted in significant improvements in

some strength and function parameters compared with placebo, there was no

significant difference in ankle range of motion between groups. Increasing the

prednisone dose to 1.5 mg/kg/day had no significant effect on ankle range of

motion. One study evaluated early surgery in 20 young boys with Duchenne

muscular dystrophy. Surgery resulted in increased ankle dorsiflexion range at 12

months but functional outcomes favoured the control group. By 24 months, many

boys in the surgical group experienced a relapse of achilles tendon

contractures.

AUTHORS' CONCLUSIONS: There is no evidence of significant benefit from any

intervention for increasing ankle range of motion in Charcot-Marie-Tooth disease

type 1A or Duchenne muscular dystrophy. Further research is required.