S.P.53 Interventions for increasing ankle flexibility in patients with neuromuscular disease: A Cochrane Systematic Review

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Abstract

Reduced ankle flexibility is a common and disabling problem for patients with neuromuscular disease. Clinicians devote considerable time providing interventions to correct this problem although few of these have been subject to rigorous investigation.The aim was to assess the effect of interventions to improve ankle flexibility in people with neuromuscular disease. Design: Cochrane Systematic Review. We searched multiple sources for randomised controlled trials investigating any intervention aimed at improving ankle flexibility in individuals with a confirmed neuromuscular disorder and reduced ankle dorsiflexion range of motion. Interventions could include but were not limited to stretching, exercise, orthotic devices, surgery or medications. The primary outcome measure was ankle dorsiflexion range of motion (ROM). Secondary outcome measures included motor function, foot alignment, foot and ankle muscle strength, health-related quality of life and adverse events. To measure treatment effect the mean difference and 95% confidence intervals were estimated. Four randomised controlled trials involving 149 participants met inclusion criteria for the review. Two evaluated night splinting in individuals with Charcot–Marie–Tooth disease type 1A (CMT1A) and the others investigated prednisone and orthopaedic surgery for boys with Duchenne muscular dystrophy (DMD). No statistically significant differences in ankle dorsiflexion ROM were observed for any intervention except for orthopaedic surgery. At 1 year surgically treated boys with DMD had better ankle dorsiflexion ROM than boys managed conservatively, although this was not sustained at 2 years and functional outcomes favoured the control group. Clinicians have limited evidence upon which to base decision making regarding interventions for increasing ankle dorsiflexion ROM in patients with DMD and CMT1A. Future research in this area is clearly warranted.

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