Seven studies (n=109) were included: 3 randomised controlled trials (RCTs, n=55), 1 crossover RCT (n=13), 1 before-and-after study (n=30) and 2 multiple single-subject studies (n=11).
In terms of study quality, the PEDro scores ranged from 4 to 8 and 4 studies were graded as level I RCTs. None of the studies reported concealed allocation, 2 studies reported blinded outcome assessment in all or 50% of the patients, all studies reported ITT analysis, and the 4 RCTs reported point estimates of variability for one or more outcomes.
Range of motion (5 studies).
Two studies of manual stretching (one level I and one level III) reported an increase in range of motion after stretching. One level II study of manual stretching reported a loss of range of motion after passive stretching ceased in one of four treatment periods. Two studies (one level I study using apparatus and one level V study of manual stretching) reported no difference in range of motion associated with passive stretching.
Spasticity (4 studies).
All 4 studies that measured this outcome (three level I and one level II) reported a reduction in spasticity post-treatment (three used apparatus and one evaluated manual stretching).
Gait (1 study).
This level I study evaluated gait after standing stretches on a tilt table and reported no significant changed in gait patterns associated with passive stretching.
Manual and sustained stretching (3 studies).
Two of the 3 level I studies that evaluated sustained stretching reported a significant decrease in spasticity associated with passive stretching; the third study concluded there was no clinically significant treatment effect.