03402nas a2200409   4500000000100000008004100001653001000042653001100052653001100063653000900074653002200083653001600105653003200121653001600153653002300169653003700192653002300229653001200252653001900264653001200283653003000295653003300325653000900358653001200367653002000379100001600399700001700415700001500432700002200447700002000469700002000489245019900509300001000708490000700718520225300725022001402978       2014                            d10aAdult10aFemale10aHumans10aMale10aTreatment Outcome10aMiddle Aged10aPhysical Therapy Modalities10aContracture10aPatient Compliance10aOutcome Assessment (Health Care)10aDisease Management10aPosture10aBrain Injuries10aWalking10aCombined Modality Therapy10aElectric Stimulation Therapy10aFoot10aSplints10aTilt-Table Test1 aHarvey Lisa1 aMoseley Anne1 aLeung Joan1 aWhiteside Bhavini1 aSimpson Melissa1 aStroud Katarina00aStanding with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury: a randomised trial.  a201-80 v603 a<p>
<b>QUESTION: </b>Is a combination of standing, electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe brain injury?
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<b>DESIGN: </b>A multi-centre randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis.
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<b>PARTICIPANTS: </b>Thirty-six adults with severe traumatic brain injury and ankle plantarflexion contractures.
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<b>INTERVENTION: </b>All participants underwent a 6-week program. The experimental group received tilt table standing, electrical stimulation and ankle splinting. The control group received tilt table standing alone.
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<b>OUTCOME MEASURES: </b>The primary outcome was passive ankle dorsiflexion with a 12Nm torque. Secondary outcomes included: passive dorsiflexion with lower torques (3, 5, 7 and 9Nm); spasticity; the walking item of the Functional Independence Measure; walking speed; global perceived effect of treatment; and perceived treatment credibility. OUTCOME MEASURES were taken at baseline (Week 0), end of intervention (Week 6), and follow-up (Week 10).
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<b>RESULTS: </b>The mean between-group differences (95% CI) for passive ankle dorsiflexion at Week 6 and Week 10 were -3 degrees (-8 to 2) and -1 degrees (-6 to 4), respectively, in favour of the control group. There was a small mean reduction of 1 point in spasticity at Week 6 (95% CI 0.1 to 1.8) in favour of the experimental group, but this effect disappeared at Week 10. There were no differences for other secondary outcome measures except the physiotherapists' perceived treatment credibility.
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<b>CONCLUSION: </b>Tilt table standing with electrical stimulation and splinting is not better than tilt table standing alone for the management of ankle contractures after severe brain injury.
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<b>TRIAL REGISTRATION: </b>ACTRN12608000637347. [Leung J, Harvey LA, Moseley AM, Whiteside B, Simpson M, Stroud K (2014) Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury: a randomised trial.Journal of Physiotherapy60: 201-208].
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