A scoping review on active vs. passive range of motion approaches to treat heterotopic ossification at the elbow.
Patricia Siegel, Shanna Smith, Emily Stark and 2 others
PMID 38903480WHAT IT FOUND
Little evidence supports active or passive elbow range-of-motion exercises for heterotopic ossification.
Five studies show mixed outcomes, so treatment needs team discussion rather than a proven protocol.
Key findings
01Only five studies met the review's inclusion criteria, and all received a PEDro score of three, considered poor evidence.
02Passive range of motion under anesthesia gave mixed elbow outcomes: 62% gained an average of 47 degrees, but three patients did not gain or lost range.
03In one active range-of-motion study, six patients responded and six required surgery.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only five studies remained after screening, and all were case series or retrospective chart reviews. All five included studies received a PEDro score of three, considered poor evidence. Sample sizes were 2, 3, 12, 18, and 9 patients, with 13 elbows in one study. The review did not find direct comparisons of active and passive range of motion. The included studies did not clearly define passive range of motion versus passive stretching. The review reports 218 articles in the methods and 219 in the results. Some patients in the Crawford and Peterson active range-of-motion studies may have been the same.
Declared interests
The authors declared no financial support for the research, authorship, or publication.
The easy way to misread this
Do not read the reported gains as proof that either approach works. The review found only five poor-quality studies, and in the active range-of-motion series six of 12 and eight of 18 patients required surgery.