Effect of Proprioceptive Neuromuscular Facilitation (PNF) versus Sustained Stretching on Spasticity-Related Pain and Stiffness in Adults with Chronic Stroke: A Randomized Control Trial
Abstract
Background: Post-stroke spasticity may contribute to pain, stiffness, restricted movement, and reduced functional ability. Proprioceptive neuromuscular facilitation (PNF) and sustained stretching are commonly used, but their comparative effects on spasticity-related symptoms in chronic stroke remain unclear. Objective: To compare PNF and sustained stretching for spasticity-related pain and stiffness in adults with chronic stroke. Methodology: This two-arm, parallel-group randomized controlled trial included 36 adults with chronic stroke, randomly allocated to PNF (n=18) or sustained stretching (n=18). Both groups received supervised 35-minute sessions for six weeks. Standardized conventional physiotherapy, where applicable, was maintained in both groups. Participants and treating therapists were not blinded; outcome assessment was performed by an assessor unaware of treatment allocation where possible. Pain was assessed using the Numerical Pain Rating Scale, stiffness using the numerical stiffness measure recorded during the original data collection, and spasticity using the Modified Ashworth Scale. All participants completed treatment and post-intervention assessment. Results: Pain decreased by 2.01 points in the PNF group and 1.38 points in the sustained stretching group, with a significant between-group difference (t=14.36, p < 0.001). Stiffness decreased by 1.94 and 1.67 points, respectively, without a significant between-group difference (t=1.52, p=0.138). Modified Ashworth Scale scores decreased by 0.67 and 0.57 points, respectively, with no significant between-group difference (t=1.44, p=0.159). Conclusion: Both interventions improved pain, stiffness, and spasticity after six weeks. PNF significantly reduced pain more than sustained stretching, while stiffness and spasticity improvements were comparable between groups.