Purpose: Stretching increases muscle-tendon flexibility, improves range of motion or musculoskeletal function, and prevents injuries. Although well-established stretching protocols are commonly used in clinical settings, the absolute and relative effectiveness of these protocols are poorly understood. Our objective was to identify and evaluate the evidence for the effectiveness of stretching in the treatment of musculoskeletal disorders.
Methods: English- and Japanese-language studies were identified through searches of MEDLINE, PEDro, CENTRAL, CINAHL, and ICHUSHI up to and including August 2009. Controlled studies (randomized controlled trials or controlled clinical trials) we selected examined patients with musculoskeletal disorders who received stretching alone. Two authors independently screened search results, assessed methodological quality, and extracted data Effect sizes and 95% confidence intervals were calculated and a meta-analysis was performed where appropriate.
Results: Twenty-five trials met the inclusion criteria. Stretching had a statistically beneficial effect on improvements in restriction of dorsiflexion movement, frozen shoulder, low-back pain, knee osteoarthritis, hamstring injuries, plantar heel pain, neck pain, and fibromyalgia. There is insufficient evidence from trials to draw conclusions on the effectiveness of stretching as a single treatment used to improve upper-limb disorders after stroke or knee flexion contractures.
Conclusion: This review provides good evidence for the beneficial effect of stretching in the treatment of some musculoskeletal disorders. However, some trials were compromised by poor methodology, including lack of blinding and incomplete outcome data. Further research, especially well-conducted randomized controlled trials, is urgently needed to confirm that stretching can improve other diseases and to determine the proper role of stretching in the clinical practice of physical therapy.

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Purpose: The purpose of this study was to examine the relationship between physical performances and activities of daily living (ADL) decline during the 6 months in the elderly people who were certified in Japanese long-term care insurance.
Methods: The participants were 175 (mean age 81.4 ± 6.4 years) elderly people who were utilized day-care services. The measurements of physical performance were the grip strength, chair stand test-5times, one-leg standing with eyes-open, walking speed, and timed “up & go” test. The 13 motor subscales of functional independence measure (FIM) were used to assess ADLs and classified into following three categories; self-care, sphincter control, and transfer/locomotion functions. The participants were divided into two groups; the ADL declining group who are decreased 1 item of each ADL classification at least and the ADL maintaining group who maintains or improves the ADLs during 6 month-period. Multiple logistic regression analyses were used to examine the relation between the declines and the physical performances at baseline.
Results: The multiple logistic regression model revealed that the timed “up & go” test was significantly associated with the decline in the ADL subcategory of transfer/locomotion function (OR; 1.11,95% CI; 1.02-1.20, p < 0.05).
Conclusions: The results suggested that the timed “up & go” test was useful to predict the functional decline of transfer/locomotion in the elderly people. Further research included multidimensional factors is needed to identify the predictor of self-care and sphincter control functions.

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Purpose: The aim of this cross sectional study is to explore the environment factors associating with the frequency of going outdoors among Japanese community-dwelling dependent older people.
Method: The subjects were 77 day-rehabilitation services users. The multiple logistic regression analysis was conducted to identify the basic attributes and the environmental factors associating with the condition of lower frequency of going outdoors. The frequency of going outdoors in a week was set as the dependent variable. The subjects' environmental factors, sex, age, comorbidity, the level of activity of daily living, the location of the day-rehabilitation services providers, the weekly frequency of day-rehabilitation service use were used as the independent variables. Japanese version of Home And Community Environment (HACE) was used to scale the environmental factors.
Result: More than 3 points of the community mobility score in Japanese version of HACE, indicating higher existence of the community barriers, was associated with the condition of never going outdoors in a week excluding day rehabilitation service use (Adjusted Odds Ratio [95% Confidence Interval]: 8.84 [1.80-67.02]). Moreover, the similar result was shown in the secondary analysis, counting day rehabilitation service use as going outdoors in a week.
Conclusion: Our findings suggest that community barriers were identified as important environmental factors which associate with the low frequency of going outdoors among Japanese community-dwelling dependent older people.

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Purpose: The aim of this study was to determine the relationship between 5-m walking time and the need for long-term care among community-dwelling adults aged above 75 years.
Methods: A total of 190 older individuals living aged ≥ 75 years (mean age, 80.1 [SD 4.2] years) and living at home participated in this study. Inpatients and current recipients of long-term care were excluded. In the baseline survey, participants performed the 5-m walking test and were followed-up for 39 months.
Results: During the 39-month follow-up, 34 participants (17.9%) were certified for long-term care need. The log-rank test of survival curves indicated that the number of subjects certified for long-term care during the follow-up period was significantly higher in the slower walking speed group than in the faster walking speed group (p < 0.001). Cox's proportional hazard model revealed that the 5-m walking speed and body mass index were significantly associated with the need for long-term care during the 39 months follow-up period, and the hazard ratio of 5-m walking speed was 1.65 (p < 0.01).
Discussion and Conclusion: These results suggested that the slow usual walking speed could relate to the future need for long-term care in community-dwelling older adults.

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Purpose: The present study evaluated the use of bathroom scales for measuring isometric strength.
Methods: We compared maximal isometric strength measured using bathroom scales and a hand-held dynamometer in 23 healthy individuals without a history of musculoskeletal or neurological disorders. An examiner stood on the bathroom scale and conducted the manual muscle test for each participant. Strength was calculated as the change in the value on the bathroom scale. Maximal isometric strength was measured in the shoulder flexors, knee extensors and hip abductors on the right side.
Results: The mean strengths measured using the bathroom scale were 149.2 ± 33.5 N, 221.1 ± 47.4 N and 172.1 ± 31.7 N for the shoulder flexor, knee extensor and hip abductor, respectively. Similarly, the mean strengths measured using the hand-held dynamometer were 141.7 ± 28.8 N, 212.5 ± 43.8 N and 167.0 ± 28.4 N, respectively. The mean errors of strength measured using the two methods were 5.2 ± 2.6% (CV 86.6%) in the shoulder flexor, 4.5 ± 3.1% (CV 92.6%) in the knee extensor, and 3.1 ± 2.7% (CV 125.9%) in the hip abductor, and the interclass correlation coefficients were 0.98 (p < 0.001) for all three results.
Conclusion: These results indicate that measurements of isometric strength using a bathroom scale and a hand-held dynamometer are in agreement. Thus, bathroom scales can be used to measure isometric strength. This method of measuring isometric strength would be useful for clinically evaluating patients whose activities are restricted because of reduced muscle strength.

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