A Cochrane review included one RCT with a total of 191 subjects. All participants were of age 60 years or over and had received a repeat prescription from their general practitioner of quinine for nighttime cramps within 3 months. The mean age was 74.3 years. The data from the participants who were advised to continue taking quinine are included here. Only the effect of calf stretching exercises was considered in this review. Forty-nine participants were advised to complete lean-to-wall calf muscle stretching held for 10 s three times per day and 48 participants were allocated to a placebo stretching group. Participants were allowed to swap intervention groups after six weeks, the study does not report how many of the participants modified their intervention. The primary outcome was 'number of cramps in the last 4 weeks'. Participants were asked in a postal survey 12 weeks from baseline to recall how many night cramps they had experienced in the previous four weeks. After 12 weeks, there was no statistically significant difference in recalled cramp frequency between groups (MD 1.19, 95% CI -5.86 to 8.25).
Comment: The quality of the evidence is downgraded by study quality (participants were allowed to change their treatment at 6 weeks but the number of modifiers is not reported, recall bias due to the postal survey method to collect the outcome data), imprecise results (limited study size and only part of the patients from the study included in the review) and indirectness of evidence (differences in studied patients, interventions and outcomes).
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