There were also minor deviations from the protocol related to the timing of assessments (Table 2). The deviations were due to early discharges, public holidays, medical problems and acute illnesses. The blinding of the assessors was reasonably successful. Assessors were unblinded in two of the end-of-intervention assessments and one of the follow-up assessments. In two of these assessments, a third person, who was otherwise not involved in the study, was asked to take the readings from the dynamometer for the passive ankle range. The mean between-group differences (95% CI) for passive ankle dorsiflexion with 12 Nm torque at Week 6 and Week 10 were –3 deg selleck compound (–8 to 2) and –1 deg (–6 to 4), respectively (Figure

3). Both were in favour of the control group (ie, the control group had 3 deg and 1 deg more passive dorsiflexion, on average, compared to the experimental group at Week 6 and Week 10, respectively). However, both effects were less than the pre-specified minimum worthwhile treatment effect of 5 deg. There was a mean reduction in spasticity of 1 PFI-2 in vivo point (95% CI 0.1 to 1.8) at Week 6, favouring the experimental group, but this effect disappeared at Week 10. No between-group differences were found for walking speed, the walking item of the Functional Independence Measure, and participants’ and physiotherapists’ global perceived effect of treatment. All the primary and secondary outcome measures

are shown in Table 4 and Table 5 (individual participant data are presented in Table 6 in the eAddenda). Dipeptidyl peptidase Overall, there were no differences between groups for participants’ tolerance to treatment, perceived treatment benefit, perceived treatment worth, and willingness to continue with treatment. In contrast, the physiotherapists administering the intervention for the experimental group rated perceived treatment effectiveness and perceived treatment worth higher than the physiotherapists administering the control intervention. They were also twice as likely as the physiotherapists

administering the control intervention to recommend the intervention protocol to the participants if further treatment for ankle contracture was indicated (81 versus 39%). Table 7 and Table 8 show participants’ and physiotherapists’ perceived treatment credibility, respectively. This study compared a multimodal treatment program with a single modality treatment program for contracture management. It was conducted because a systematic review has indicated that passive stretch alone is ineffective.3 It was hypothesised that a program of tilt table standing combined with electrical stimulation and splinting may be more effective than tilt table standing alone for the treatment of contracture. In the present study, electrical stimulation was added because it may improve strength and reduce spasticity, and thus address important contributors to contracture.