The Efficacy of Different Types of Stretching on Range of Motion, Pain and Function in Elbow Limitation

The Efficacy of Proprioceptive Neuromuscular Facilitation Stretching and Static Stretching on Range of Motion, Pain and Function in Elbow Limitation

The aim of the study is to compare the efficacy of Proprioceptive Neuromuscular Facilitation (PNF) stretching and static stretching on range of motion (ROM), pain and function in elbow limitation.

Study Overview

• Status: Completed
• Conditions: Postoperative Pain; Elbow Fracture; Stiffness of Elbow, Not Elsewhere Classified
• Intervention / Treatment: Other: PNF stretching; Other: Exercise; Other: Cold Therapy; Other: Static Stretching

Detailed Description

To compare the efficacy of PNF stretching and static stretching on ROM, pain and function in elbow limitation, forty voluntary patients with elbow limitation, aged between 18-55 years will be randomly divided into two groups: PNF Stretching group and Static Stretching group. PNF stretching will be combined with exercise and cold application in PNF Stretching group, static stretching will be combined with exercise and cold application in Static Stretching group, will be applied for 12 sessions. The patients will be assessed before and after six-week treatment. The pain on activity, at rest and at night will be assessed with Visual Analog Scale (VAS). ROM will be assesed with universal goniometer. The functional status will be evaluated by Disabilities Arm, Shoulder and Hand (DASH). Kinesiophobia and quality of life will be assessed with Tampa Scale for Kinesiophobia and Short Form-12, respectively. The Global Rating of Change will be used to evaluate patient satisfaction.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey
    • Istanbul University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Subjectswill be included with

• Aged between 18 and 65 years
• Elbow fracture in the six months before the study
• Elbow limitation in flexion or extension
• Being volunteer to participate
• Fractures should be managed with conservatively or surgically

Exclusion Criteria:

• Malunion or Nonunion Fracture
• Occurrence of complex regional pain syndrome, peripheric nerve injury, heterotopic ossification, myositis ossification or post-traumatic ankylosing
• Non-healing wound or infection
• Previously received physiotherapy for elbow limitation
• Having any cardiovascular diseases, neurological disorders, rheumatic diseases or psychiatric diseases
• Could not adjust to treatment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: PNF Stretching group; Each subject in PNF Stretching group will receive a treatment protocol consisting of PNF stretching, cold therapy and exercise.	Other: PNF stretching; For hold-relax stretching, each subject in PNF Stretching group will be comfortably positioned in a supine lying position, and patient will move the joint to the end of the passive or pain-free ROM. The therapist will ask for an isometric contraction of the restricting muscle or pattern (antagonists) with emphasis on rotation. The patients will be asked to perform submaximal isometric contractions of the target muscle for 10 seconds. After the contraction, the patients will be instructed to relax for 5 seconds. The joint will be repositioned actively to the new limit of range, and then therapist will passively control the new ROM. The procedure will be repeated 10 times with 10 seconds of rest between two successive trials. Patients will be treated 2 times per week for 6 weeks.; Other: Exercise; Shoulder, elbow and wrist AROM exercises. Elbow flexion and extansion self-stretching exercises Elbow and wrist strengthening exercises Proprioception exercises for elbow. Grip strengthening exercises.; Other: Cold Therapy; Cold therapy will be applied over the elbow for 15 minutes in the form of cold pack after stretching and exercise protocol.
Experimental: Static Stretching group; Each subject in Static Stretching group will receive a treatment protocol consisting of static stretching, cold therapy and exercise.	Other: Exercise; Shoulder, elbow and wrist AROM exercises. Elbow flexion and extansion self-stretching exercises Elbow and wrist strengthening exercises Proprioception exercises for elbow. Grip strengthening exercises.; Other: Cold Therapy; Cold therapy will be applied over the elbow for 15 minutes in the form of cold pack after stretching and exercise protocol.; Other: Static Stretching; For static stretching, each subject in Static Stretching group will be comfortably positioned in a supine lying position, and the stretching of target muscle will be maintained for 20 seconds followed by 10 seconds of rest. The procedure will be repeated 10 times with 10 seconds of rest between two successive trials. Patients will be treated 2 times per week for 6 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Functional Status	The functional status of the patients will be evaluated by The Disabilities of the Arm, Shoulder and Hand (DASH).	After the six-week intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Active Range of Motion (AROM) Assessment	The elbow's and forearm's AROM, including flexion, extansion, supination, pronation will be measured described by the American Academy of Orthopaedic Surgeons (AAOS) using a universal goniometer. The process will be repeated three times in each direction, with the the average value recorded.	Baseline
Active Range of Motion (AROM) Assessment	The elbow's and forearm's AROM, including flexion, extansion, supination, pronation will be measured described by the American Academy of Orthopaedic Surgeons (AAOS) using a universal goniometer. The process will be repeated three times in each direction, with the the average value recorded.	After the six-week intervention
Active Range of Motion (AROM) Assessment	The elbow's and forearm's AROM, including flexion, extansion, supination, pronation will be measured described by the American Academy of Orthopaedic Surgeons (AAOS) using a universal goniometer. The process will be repeated three times in each direction, with the the average value recorded.	1-month follow up
Functional Status	The functional status of the patients will be evaluated by The Disabilities of the Arm, Shoulder and Hand (DASH).	Baseline
Functional Status	The functional status of the patients will be evaluated by The Disabilities of the Arm, Shoulder and Hand (DASH).	1-month follow up
Pain Intensity	Pain intensity of the patients at rest, during activity, and at night will be assessed by Visual Analog Scale.	Baseline
Pain Intensity	Pain intensity of the patients at rest, during activity, and at night will be assessed by Visual Analog Scale.	After the six-week intervention
Pain Intensity	Pain intensity of the patients at rest, during activity, and at night will be assessed by Visual Analog Scale.	1-month follow up

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of Life	Quality of life of the patients will be assessed by Short Form-12.	Baseline
Quality of Life	Quality of life of the patients will be assessed by Short Form-12.	After the six-week intervention
Quality of Life	Quality of life of the patients will be assessed by Short Form-12.	1-month follow up
Fear of movement (kinesiophobia)	Kinesiophobia of the patients will be assessed by Tampa Kinesiophobia Scale.	Baseline
Fear of movement (kinesiophobia)	Kinesiophobia of the patients will be assessed by Tampa Kinesiophobia Scale.	After the six-week intervention
Fear of movement (kinesiophobia)	Kinesiophobia of the patients will be assessed by Tampa Kinesiophobia Scale.	1-month follow up
Patient Satisfaction	Patient Satisfaction will be assessed with Global Rating of Change Scale.	After the six-week intervention

Collaborators and Investigators

• Sponsor: Istanbul University
• Investigators: Principal Investigator: Tansu Birinci, MSc, Istanbul University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2017
• Primary Completion (Actual): May 15, 2017
• Study Completion (Actual): July 25, 2017

Study Registration Dates

• First Submitted: May 18, 2017
• First Submitted That Met QC Criteria: May 18, 2017
• First Posted (Actual): May 22, 2017

Study Record Updates

• Last Update Posted (Actual): February 23, 2018
• Last Update Submitted That Met QC Criteria: February 22, 2018
• Last Verified: February 1, 2018

More Information

Terms related to this study

• Keywords: pain; exercise; proprioceptive neuromuscular facilitation stretching; static stretching
• Additional Relevant MeSH Terms: Pathologic Processes; Postoperative Complications; Pain; Neurologic Manifestations; Pain, Postoperative
• Other Study ID Numbers: 910801

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No