Comparison of Post Facilitation Stretch and Maitland Mobilization in Post-traumatic Stiff Elbow

Comparison of Post Facilitation Stretch and Maitland Mobilization in Improving Range of Motion in Post-traumatic Stiff Elbow

This research study aims to bridge the gap in the existing literature by comparing the efficacy of Maitland mobilization and PFS techniques in the treatment of post-traumatic stiff elbow. While existing research has shown the favorable effects of joint mobilization and muscle energy techniques in other musculoskeletal conditions, there is a notable gap in understanding their efficacy in post-traumatic stiff elbow, particularly in Pakistan where no such study has been conducted. By investigating the comparative outcomes of these techniques, this research will contribute valuable clinical insights, potentially guiding clinicians in selecting the most effective treatment approach and laying the foundation for evidence-based treatment protocols tailored to patients with post-traumatic stiff elbow.

Study Overview

• Status: Completed
• Conditions: Post Traumatic Stiff Elbow
• Intervention / Treatment: Other: Maitland Mobilization; Other: Post facilitation stretch

Detailed Description

The elbow being a highly constrained synovial hinge joint has a high propensity for degeneration and stiffness. There could be functional losses seen with even less severe loss of range of motion (ROM) at the elbow. The stiff or contracted elbow is defined as an elbow with a reduction in extension greater than 30 degrees, and/or a flexion less than 120 degrees. Although supination and pronation are often reduced as well, this will not be considered further as contracture of the elbow is not related to forearm rotation. The elbow is more prone to stiffness because Brachialis muscle lies directly over the anterior capsule, the anterior capsule tends to tear more frequently than posterior, all 3 elbow articulations exist in 1 capsule, the elbow is prone to development of Heterotrophic Ossification. Loss of terminal extension is less disabling than loss of the same degree of terminal flexion. It was a randomized, controlled trial, conducted among post-traumatic stiff elbow patients. Sample size was 32 by using G Power Calculator. Participants were randomly assigned to the intervention or control group after a baseline assessment with a lottery ticket and an opaque envelope. All participants in both groups were evaluated on two occasions: (i) baseline (ii) After 4 weeks of intervention

• Study Type: Interventional
• Enrollment (Actual): 32
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Rawalpindi, Punjab, Pakistan, 46300
      • Railway General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 18 - 35 years
• Both male and female
• Patients with a limitation of elbow joint range of motion greater than 30 degrees in extension and less than 120 degrees in flexion.
• 2-3 months after POP, splinting
• Patients having bone ossification on X-ray findings will be included.

Exclusion Criteria:

• Patients with a history of rheumatoid arthritis or other inflammatory joint diseases
• Mal-union or non- union elbow fracture.
• Patients with a history of neuromuscular disorders or other conditions affecting muscle tone.
• Patients with a history of previous elbow surgery or joint replacement.
• Patients with a history of traumatic brain injury or other neurological conditions affecting upper limb function.
• Patients with open reduction
• Patient with elbow dislocation
• Elbow joint mal-alignment
• Heterotopic ossification
• Myositis ossification or posttraumatic ankyloses.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Maitland Mobilization; Maitland mobilization will be applied 2-3 oscillations per second for 1 minute, 5 set each day, 5 days a week for 4 weeks.	Other: Maitland Mobilization; Hot Pack for 10 mints; Active and active-assisted exercises (10 reps x 3 sets) for the; Elbow flexion and extension; Wrist flexion and extension; Forearm supination and pronation
Active Comparator: post facilitation stretch; PFS will be performed 6-10s isometric contraction with 100 % force followed by 15s passive stretch, 4-5 repetitions per day, 5 days a week for 4 weeks.	Other: Post facilitation stretch; Hot Pack for 10 mints; Active and active-assisted exercises (10 reps x 3 sets) for the; Elbow flexion and extension; Wrist flexion and extension; Forearm supination and pronation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric pain rating scale	Changes from baseline Numeric pain rating scale is a self-administered, or analyst reported, measuring instrument comprising of a scale that shows numerical ranges usually from 0-10 or 0-100. In this scale extreme or farthest point shows having 'no pain' to having 'extreme pain'.	4 weeks
ROM Elbow (Flexion)	Changes from baseline range of motion( ROM) of elbow joint flexion is taken by using Goniometer.	4 weeks
ROM Elbow (Extension)	Changes from baseline range of motion( ROM) of elbow joint extension is taken by using Goniometer.	4 weeks
ROM Forearm (Supination)	Changes from baseline range of motion( ROM) of forearm supination is taken by using Goniometer.	4 weeks
ROM Forearm (Pronation)	Changes from baseline range of motion (ROM) of forearm pronation is taken by using Goniometer.	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Disability	Changes from baseline disability is measured through DASH (Disability of the arm, shoulder and hand) questionnaire. DASH questionnaire is a self reported area specific outcome measuring tool for symptoms and disabilities in upper limb. It mainly comprise of a 30-items scale which is further consist of questions related to difficulty in performing normal daily activities, scored on 5 response options. Scores for these 30 items then calculate on a scale of 0 (no disability) to 100 (most severe disability)	4 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Nadia ishtiaq, MSOMPT, Riphah International University

Publications and helpful links

General Publications

• 2. Manske RC, Magee DJ. Orthopedic physical assessment-E-Book: Elsevier Health Sciences; 2020. 3. Nandi S, Maschke S, Evans PJ, Lawton JNJH. The stiff elbow. 2009;4(4):368-79. 4. Bruno RJ, Lee ML, Strauch RJ, Rosenwasser MPJJ-JotAAoOS. Posttraumatic elbow stiffness: evaluation and management. 2002;10(2):106-16. 5. Doornberg JN, Ring D, Jupiter JBJJoot. Static progressive splinting for posttraumatic elbow stiffness. 2006;20(6):400-4. 6. Edward SJKM. Elbow passive motion rehabilitation utilizing a continuous passive motion device following surgical release, manipulation under anesthesia, or post stable fracture: A review. 2006. 7. MacDermid JC, Vincent JI, Kieffer L, Kieffer A, Demaiter J, MacIntosh SJTooj. A survey of practice patterns for rehabilitation post elbow fracture. 2012;6:429.

Study record dates

Study Major Dates

• Study Start (Actual): February 15, 2023
• Primary Completion (Actual): January 15, 2024
• Study Completion (Actual): January 15, 2024

Study Registration Dates

• First Submitted: September 15, 2023
• First Submitted That Met QC Criteria: September 21, 2023
• First Posted (Actual): September 22, 2023

Study Record Updates

• Last Update Posted (Estimated): March 5, 2024
• Last Update Submitted That Met QC Criteria: March 4, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: Post facilitation stretch.; Maitland.; Stiff elbow
• Other Study ID Numbers: RCRAHS-ISB/REC/MS-PT/01608

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