RESEARCH REPORT PLATFORM PRESENTATION

IS NIGHT SPLINTING AS EFFECTIVE AS TILT TABLING AT PREVENTING ANKLE CONTRACTURE EARLY AFTER STROKE: A RANDOMISED CONTROLLED TRIAL. Ada L¹, Robinson W², Smith R³, Aung O⁴; ¹University of Sydney, Sydney, Australia. ²Bankstown Hospital, Sydney, Australia. ³Multiple Sclerosis Centre, Sydney, Australia. ⁴St. George Hospital, Sydney, Australia

PURPOSE: To examine the efficacy of prolonged stretching (via overnight splinting vs tilt-tabling) in preventing ankle dorsiflexion contracture early after stroke. RELEVANCE: Calf shortening is a common problem after stroke. Limitation in ankle range is a major secondary problem after stroke which leads to reduced mobility and independence. PARTICIPANTS: 29 stroke patients who were previously ambulatory, within 2 weeks of a first disabling stroke, currently immobile but had not already developed contracture in the affected ankle of greater than 10 degrees compared with the non affected limb, had no pre-existing skin or circulatory problems contraindicating application of splints and did not have severe difficulty in communication participated in the study. The study was approved by the individual hospital and university ethics committees and subjects gave informed consent before initial measures were completed. METHODS: A randomised controlled trial was carried out in two metropolitan mixed rehabilitation units. The experimental group had their affected ankle splinted at plantargrade overnight and the control group were stood on a tilt table with the affected ankle at maximum dorsiflexion for 30 min. Maximum passive ankle dorsiflexion and the sit-to-stand item of the Motor Assessment Scale were measured before and after 4 weeks of intervention, and after 6 weeks follow up by an assessor blinded to group allocation. ANALYSIS: Two-way ANOVAs (group x time) were used to determine whether there was a greater effect of the night splinting program than the tilt table program on maximum passive dorsiflexion and sit-to-stand performance. Analysis of data from Weeks 0 and 4 compared the immediate effect of the splinting program with the tilt table program while analysis of data from Weeks 0 and 10 determined whether any benefits of the intervention were maintained. RESULTS: There was no difference in the change in maximum passive dorsiflexion between the night splinting group and the tilt tabling group, either by Week 4 (p = 0.61) or by Week 10 (p = 0.75). However, neither group lost range in their ankles over the intervention period. The experimental group started at 14 deg and finsished at 14 deg which was similar to the control group who started at 12 deg and finished at 14 deg. Both groups lost 4 deg in the 6 weeks following the cessation of intervention. CONCLUSIONS: Night splinting appears to be as effective as titl tabling at preventing ankle contractures after stroke. IMPLICATIONS: Clinicians can choose to implement night splinting or tilt tabling to prevent ankle contracture depending on the requirements of the individual patient. KEYWORDS: stroke, stretch, contracture. FUNDING ACKNOWLEDGEMENTS: The Physiotherapy Research Foundation of Australia. CONTACT: l.ada@fhs.usyd.edu.au

ETHICS COMMITTEE: The Ethics COmmittee for humna research, the University of Sydney