QUESTION: Is a combination of standing, electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe brain injury? DESIGN: A multi-centre randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: Thirty-six adults with severe traumatic brain injury and ankle plantarflexion contractures. INTERVENTION: All participants underwent a 6-week program. The experimental group received tilt table standing, electrical stimulation and ankle splinting. The control group received tilt table standing alone. OUTCOME MEASURES: The primary outcome was passive ankle dorsiflexion with a 12Nm torque. Secondary outcomes included: passive dorsiflexion with lower torques (3, 5, 7 and 9 Nm); spasticity; the walking item of the Functional Independence Measure; walking speed; global perceived effect of treatment; and perceived treatment credibility. OUTCOME MEASURES were taken at baseline (week 0), end of intervention (week 6), and follow-up (week 10). RESULTS: The mean between-group differences (95% CI) for passive ankle dorsiflexion at week 6 and week 10 were -3 degrees (-8 to 2) and -1 degrees (-6 to 4), respectively, in favour of the control group. There was a small mean reduction of 1 point in spasticity at week 6 (95% CI 0.1 to 1.8) in favour of the experimental group, but this effect disappeared at week 10. There were no differences for other secondary outcome measures except the physiotherapists' perceived treatment credibility. CONCLUSION: Tilt table standing with electrical stimulation and splinting is not better than tilt table standing alone for the management of ankle contractures after severe brain injury. TRIAL REGISTRATION: ACTRN12608000637347.

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