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Ali M, Tibble H, Brady MC, Quinn TJ, Sunnerhagen KS, Venketasubramanian N, Shuaib A, Pandyan A, Mead G. Validation of general pain scores from multidomain assessment tools in stroke. Front Neurol 2024; 15:1328832. [PMID: 38333610 PMCID: PMC10851776 DOI: 10.3389/fneur.2024.1328832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Purpose We describe how well general pain reported in multidomain assessment tools correlated with pain-specific assessment tools; associations between general pain, activities of daily living and independence after stroke. Materials and methods Analyses of individual participant data (IPD) from the Virtual International Stroke Trials Archive (VISTA) described correlation coefficients examining (i) direct comparisons of assessments from pain-specific and multidomain assessment tools that included pain, (ii) indirect comparisons of pain assessments with the Barthel Index (BI) and modified Rankin Scale (mRS), and (iii) whether pain identification could be enhanced by accounting for reported usual activities, self-care, mobility and anxiety/depression; factors associated with pain. Results European Quality of Life 3- and 5-Level (EQ-5D-3L and EQ-5D-5L), RAND 36 Item Health Survey 1.0 (SF-36) or the 0-10 Numeric Pain Rating Scale (NPRS) were available from 10/94 studies (IPD = 10,002). The 0-10 NPRS was the only available pain-specific assessment tool and was a reference for comparison with other tools. Pearson correlation coefficients between the 0-10 NPRS and (A) the EQ-5D-3L and (B) EQ5D-5 L were r = 0.572 (n = 436) and r = 0.305 (n = 1,134), respectively. mRS was better aligned with pain by EQ-5D-3L (n = 8,966; r = 0.340) than by SF-36 (n = 623; r = 0.318). BI aligned better with pain by SF-36 (n = 623; r = -0.320). Creating a composite score using the EQ-5D 3 L and 5 L comprising pain, mobility, usual-activities, self-care and anxiety/depression did not improve correlation with the 0-10 NPRS. Discussion The EQ-5D-3L pain domain aligned better than the EQ-5D-5L with the 0-10 NPRS and may inform general pain description where resources and assessment burden hinder use of additional, pain-specific assessments.
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Affiliation(s)
- Myzoon Ali
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Holly Tibble
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marian C. Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Terence J. Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Katharina S. Sunnerhagen
- Department of Clinical Neuroscience, University of Gothenburg, Sweden and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Anand Pandyan
- Faculty of Health and Social Sciences, Bournemouth University, Poole, United Kingdom
| | - Gillian Mead
- Geriatric Medicine, Division of Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Clinical and radiological assessment of hemiplegic shoulder pain in stroke patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00474-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hemiplegic shoulder pain (HSP) is one of the most common complications of stroke. This work aimed to evaluate and analyze the clinical and radiological features of painful shoulder in hemiplegic stroke patients with evaluating the diagnostic role of shoulder ultrasound and shoulder MR imaging in assessment of the causes of shoulder pain.
Methods
210 stroke patients with shoulder affection within 3 years of stroke development were enrolled. Clinical assessment including Medical Research Council scoring, The Brunnström motor recovery and Ashworth Scale. Shoulder ultrasound and MR imaging were done for 74 patients with painful hemiplegic shoulder.
Results
The prevalence of HSP was 35.2% with statistically significantly higher proportion of shorter disease duration, lower muscle power, lower BMR stage with higher proportion of bicipital tendinitis and complex regional pain syndrome in major versus moderate dependence (P < 0.001, P < 0.001, P < 0.001, P = 0.011 and P = 0.001 respectively). On multivariate analysis only short disease duration was statistically significant independent predictor. Participants with disease duration ≤ 2 months have 21.9 times higher odds to exhibit major rather than moderate dependence. By imaging there was high prevalence of joint effusion (47.3%), bicipital tendinitis (44.6%), bursitis (31%) and adhesive capsulitis (29.7%) in painful hemiplegic shoulder with a very good agreement between MRI and US in diagnosis.
Conclusion
HSP has a high prevalence in stroke patient with increased morbidity due to various factors and US can be used as an alternative or a complementary to MRI for diagnosis of hemiplegic shoulder pain.
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Zhang Q, Chen D, Shen Y, Bian M, Wang P, Li J. Incidence and Prevalence of Poststroke Shoulder Pain Among Different Regions of the World: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:724281. [PMID: 34803873 PMCID: PMC8600331 DOI: 10.3389/fneur.2021.724281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Poststroke shoulder pain (PSSP) is a common complication after stroke. This review aimed to provide updated information on the epidemiological characteristics of PSSP, reveal their trends over time and region. Study Design and Setting: We searched the PubMed, Embase, Cochrane Library and Web of Science databases from inception until Dec 31, 2020. Data were extracted from the eligible studies, and their quality was assessed. The pooled incidence and prevalence estimates of PSSP and their 95% confidence intervals (CIs) were calculated. We analyzed the incidence and prevalence of PSSP by different geographical regions and countries and separately calculated the annual incidence and prevalence (and 95% CIs) of PSSP. Results: A total of 21 studies were eligible for the meta-analysis. Eleven cohort studies were included to analyze the incidence of PSSP, and the estimated pooled incidence in 3,496 stroke patients was 0.29 (95% CI 0.21-0.36). Ten cross-sectional studies were included to analyze the prevalence of PSSP, and the pooled prevalence in 3,701 stroke patients was 0.33 (95% CI 0.22-0.43). In addition, we found that there were significant differences in the incidence and prevalence of PSSP between different geographical regions and different countries. Additionally, the incidence of PSSP fluctuated around 30%, and the prevalence had a downward trend over time. Conclusions: Current evidence suggests that the incidence and prevalence of PSSP are high and may be influenced by geographical region and time.
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Affiliation(s)
- Qian Zhang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Danna Chen
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Yuxian Shen
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Minjie Bian
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Jun Li
- Department of Urology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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Alekseyev K, Iskander P, De Santo P. Implementing a Pain Assessment Survey and Team Approach Method to Effectively Assess and Treat Pain in Poststroke Patients. Arch Rehabil Res Clin Transl 2020; 2:100058. [PMID: 33543085 PMCID: PMC7853384 DOI: 10.1016/j.arrct.2020.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To monitor and treat pain effectively in stroke patients in an inpatient rehabilitation facility using an efficient Pain Assessment Survey. DESIGN The study was conducted as a 2-part project. Part 1 was a preintervention study conducted to assess the prevalence of pain in poststroke patients using a Pain Assessment Survey. Factors such as central and peripheral mechanisms, psychological factors, and autonomic input were used to study the surveyed population. Other potential risk factors, such as age and sex, were also incorporated into statistical gathering. The correlation between the presence of pain and poststroke patients was assessed, and an enhanced pain assessment was created and implemented in the admission process of poststroke patients. This helped comprise part of the second portion of the study, the postintervention study. SETTING Participants were chosen from an inpatient rehabilitation facility. Each part of the project was conducted over a 6-month period. PARTICIPANTS Patients (N=184) were randomly selected. Eighty-two patients were included in the preintervention survey, and 102 patients were included in the postintervention survey. Those who had pain prior to stroke that remained unchanged or if the pain was secondary to another diagnosis were excluded from the study. INTERVENTION Patients with complaints of poststroke pain (PSP) were intervened immediately upon admission using a team approach. This included all personnel involved in the patient's care to resolve pain before discharge. Different types of medications and non-medical modalities were used for pain control. MAIN OUTCOME MEASURE The prevalence of PSP in poststroke patients. RESULTS The preintervention survey revealed a pain prevalence of 31.7%, whereas the postintervention study showed a prevalence of 11.8% in poststroke patients on admission. The odds that a poststroke patient would be discharged without pain and with a proper pain assessment and management was 96.2, with a statistically significant P value of .0015. CONCLUSION The team approach to pain management resulted in all patients being successfully treated and discharged pain free. This further demonstrates the importance of using both a pain assessment survey and team approach to assess PSP in poststroke patients.
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Affiliation(s)
- Kirill Alekseyev
- Pain Management and Rehabilitation, Kingsbrook Jewish Medical Center, Brooklyn, NY
| | - Peter Iskander
- Pain Management and Rehabilitation, Kingsbrook Jewish Medical Center, Brooklyn, NY
| | - Patrick De Santo
- Pain Management and Rehabilitation, Kingsbrook Jewish Medical Center, Brooklyn, NY
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Teasell R, Salbach NM, Foley N, Mountain A, Cameron JI, Jong AD, Acerra NE, Bastasi D, Carter SL, Fung J, Halabi ML, Iruthayarajah J, Harris J, Kim E, Noland A, Pooyania S, Rochette A, Stack BD, Symcox E, Timpson D, Varghese S, Verrilli S, Gubitz G, Casaubon LK, Dowlatshahi D, Lindsay MP. Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Community Participation following Stroke. Part One: Rehabilitation and Recovery Following Stroke; 6th Edition Update 2019. Int J Stroke 2020; 15:763-788. [PMID: 31983296 DOI: 10.1177/1747493019897843] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The sixth update of the Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Reintegration following Stroke. Part one: Rehabilitation and Recovery Following Stroke is a comprehensive set of evidence-based guidelines addressing issues surrounding impairments, activity limitations, and participation restrictions following stroke. Rehabilitation is a critical component of recovery, essential for helping patients to regain lost skills, relearn tasks, and regain independence. Following a stroke, many people typically require rehabilitation for persisting deficits related to hemiparesis, upper-limb dysfunction, pain, impaired balance, swallowing, and vision, neglect, and limitations with mobility, activities of daily living, and communication. This module addresses interventions related to these issues as well as the structure in which they are provided, since rehabilitation can be provided on an inpatient, outpatient, or community basis. These guidelines also recognize that rehabilitation needs of people with stroke may change over time and therefore intermittent reassessment is important. Recommendations are appropriate for use by all healthcare providers and system planners who organize and provide care to patients following stroke across a broad range of settings. Unlike the previous set of recommendations, in which pediatric stroke was included, this set of recommendations includes primarily adult rehabilitation, recognizing many of these therapies may be applicable in children. Recommendations related to community reintegration, which were previously included within this rehabilitation module, can now be found in the companion module, Rehabilitation, Recovery, and Community Participation following Stroke. Part Two: Transitions and Community Participation Following Stroke.
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Affiliation(s)
- Robert Teasell
- Stroke Rehabilitation Program, 60446Parkwood Hospital, London, Canada
- Western University, London, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | | | - Anita Mountain
- Division of Physical Medicine and Rehabilitation, 3688Dalhousie University, Halifax, Canada
- Queen Elizabeth II Health Sciences Centre, Nova Scotia Rehabilitation Centre Site, Halifax, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Andrea de Jong
- 33484Heart and Stroke Foundation of Canada, Toronto, Canada
| | - Nicole E Acerra
- Neurosciences and Physical Therapy, Vancouver Coastal Health, Vancouver, Canada
| | - Diana Bastasi
- School of Physical and Occupational Therapy, 5620McGill University, Montréal, Canada
| | - Sherri L Carter
- Department of Psychology and Neuroscience, 3688Dalhousie University, Halifax, Canada
| | - Joyce Fung
- School of Physical and Occupational Therapy, 5620McGill University, Montréal, Canada
- Jewish Rehabilitation Hospital (CISSS-Laval) research site of CRIR, Montréal, Canada
| | - Mary-Lou Halabi
- Stroke Program, Edmonton Zone, Alberta Health Services, Edmonton, Canada
| | | | - Jocelyn Harris
- School of Rehabilitation Sciences, 3710McMaster University, Hamilton, Canada
| | - Esther Kim
- Department of Communication Sciences and Disorders, 3158University of Alberta, Edmonton, Canada
| | - Andrea Noland
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Sepideh Pooyania
- Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Canada
| | - Annie Rochette
- School of Rehabilitation, University of Montreal, Montreal, Canada
| | | | - Erin Symcox
- Tertiary Neuro Rehabilitation, 26634Foothills Medical Centre, Calgary, Alberta
| | - Debbie Timpson
- Physical Medicine and Rehabilitation, 153197Pembroke Regional Hospital, Pembroke, Canada
| | - Suja Varghese
- Rehabilitation and Palliative Care Program, 102793Eastern Health, Newfoundland and Labrador, St. John's, Canada
| | - Sue Verrilli
- Northeastern Ontario Stroke Network, Sudbury, Canada
| | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre Stroke Program, Halifax, Canada
| | | | - Dar Dowlatshahi
- Faculty of Medicine, 6363University of Ottawa, Ottawa, Canada
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Ratanapinunchai J, Mathiyakom W, Sungkarat S. Scapular Upward Rotation During Passive Humeral Abduction in Individuals With Hemiplegia Post-stroke. Ann Rehabil Med 2019; 43:178-186. [PMID: 31072084 PMCID: PMC6509579 DOI: 10.5535/arm.2019.43.2.178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022] Open
Abstract
Objective To describe scapular upward rotation during passive humeral abduction in individuals with hemiplegia post-stroke compared to normal subjects. Methods Twenty-five individuals with hemiplegia post-stroke and 25 age- and gender-matched normal subjects voluntarily participated in this study. Scapular upward rotation during resting and passive humeral abduction at 30°, 60°, 90°, 120°, and 150° were measured using a digital inclinometer. Results In both groups, scapular upward rotation significantly increased as humeral abduction increased (p<0.001). Scapular upward rotation was significantly less in the hemiplegic group compared to that in the control at 90° (p=0.002), 120° (p<0.001), and 150° of humeral abduction (p<0.001). The mean difference in scapular upward rotation between these two groups ranged from 6.3° to 11.38°. Conclusion Passive humeral abductions ranging from 90° to 150° can significantly alter scapular upward rotation in individuals with hemiplegia post-stroke compared to those of matched normal subjects. The magnitude of reduction of the scapular upward rotation may potentially lead to the development of hemiplegic shoulder pain after prolonged repetitive passive movement. Scapular upward rotation should be incorporated during passive humeral abduction in individuals with hemiplegia post-stroke, especially when the humeral is moved beyond 90° of humeral abduction. Combined movements of scapular and humeral will help maintain the relative movement between the scapula and humerus. However, further longitudinal study in patients with shoulder pain post-stroke is needed to confirm these findings.
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Affiliation(s)
- Jonjin Ratanapinunchai
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Witaya Mathiyakom
- Department of Physical Therapy, California State University, Northridge, CA, USA
| | - Somporn Sungkarat
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Pain LAM, Baker R, Sohail QZ, Hebert D, Zabjek K, Richardson D, Agur AMR. The three-dimensional shoulder pain alignment (3D-SPA) mobilization improves pain-free shoulder range, functional reach and sleep following stroke: a pilot randomized control trial. Disabil Rehabil 2019; 42:3072-3083. [PMID: 30907155 DOI: 10.1080/09638288.2019.1585487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background and purpose: Following a stroke, three-dimensional clavicular/scapular/humeral joint rotations may become restricted and contribute to post-stroke shoulder pain. This study examined whether a treatment group provided with current standard treatment plus the proposed "Three-dimensional Shoulder Pain Alignment" mobilization protocol demonstrated improved pain-free shoulder range, functional reach and sleep compared to a control group provided with standard treatment alone.Methods: In this double-blinded parallel-group randomized control trial, treatment and control subjects with moderate/severe post-stroke upper extremity impairment and shoulder pain were treated 3x/week for 4 weeks. Outcome measures included changes in pain-free three-dimensional clavicular/scapular/humeral range (using computerized digitization), pain during sleep and functional reach (using the Pain Intensity-Numerical Rating Scale), and pain location/prognostic indicators (using the Chedoke-McMaster Stroke Assessment-Shoulder Pain Inventory).Results: Compared to controls (n = 10) the treatment group (n = 10) demonstrated significantly improved three-dimensional clavicular/scapular/humeral pain-free range during shoulder flexion and abduction (p < 0.05; Hedges g > 0.80), large effect sizes for decreased pain during sleep and functional reach to the head and back (OR range: 5.44-21.00), and moderate effect size for improved pain/prognostic indicators (OR = 3.86).Conclusions: The Three-Dimensional Shoulder Pain Alignment mobilization protocol significantly improved pain-free range of motion, functional reach and pain during sleep in shoulders with moderate/severe post-stroke upper-extremity impairment.Implications for rehabilitationAlthough three-dimensional clavicular/scapular/humeral rotations are an essential component of normal pain-free shoulder range of motion, current guidelines for treatment of post-stroke shoulder pain only includes uni-dimensional mobilizations for joint alignment and pain management.The Three-Dimensional Shoulder Pain Alignment (3D-SPA) mobilization protocol incorporates multi-dimensional mobilizations in various planes of shoulder movement.The current study results demonstrate proof-of-concept regarding the 3D-SPA mobilization, and this approach should be considered as an alternative to the uni-dimensional mobilizations currently used in clinical treatment guidelines for post-stroke shoulder pain.
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Affiliation(s)
- Liza A M Pain
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Senior Services, Credit Valley Hospital-Trillium Health Partners, Mississauga, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Ross Baker
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Debbie Hebert
- Toronto Rehabilitation Institute (University Centre), University Health Network, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Karl Zabjek
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute (University Centre), University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Denyse Richardson
- Department of Medicine, University of Toronto, Toronto, Canada.,Department of Neuro-rehabilitation, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Anne M R Agur
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Gaitan M, Bainbridge L, Parkinson S, Cormack L, Cleary S, Harrold M. Characteristics of the shoulder in patients following acute stroke: a case series. Top Stroke Rehabil 2019; 26:318-325. [PMID: 30893022 DOI: 10.1080/10749357.2019.1590973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Stroke can result in pain and loss of motor control in the hemiplegic shoulder, and while prevention of secondary changes is likely to be the most effective management, there is limited evidence directing clinicians towards the most at-risk patients. OBJECTIVES The aim of this case series was to investigate the presentation of shoulder pain, motor impairment, shoulder passive range of motion (PROM) and alignment of the hemiplegic shoulder following acute stroke. METHODS This study reported data that was collected as part of a pilot randomized controlled trial investigating kinesiology taping of the hemiplegic shoulder. Participants with a diagnosis of acute stroke and severe upper limb motor impairment were included. From 24-h post stroke and continuing every three days until discharge, measurements of shoulder pain (visual analogue scale, Ritchie Articular Index), motor impairment (Chedoke McMaster Stroke Assessment), PROM and alignment (both clinical measures) were collected. Clinical trial registry number - ACTRN12615000502538. RESULTS Of 156 patients screened over six months, 10 of 15 eligible participants were recruited. On initial assessment, three participants reported pain and all had severe upper limb motor impairment. All participants initially demonstrated close to full shoulder PROM. Six participants had shoulder subluxation and five demonstrated scapula malalignment. CONCLUSIONS Given the severity of upper limb motor impairment, pain and reduced PROM were seen in a small number of participants. The clinical course of shoulder pain and PROM following stroke remains unclear. Large observational studies tracking shoulder characteristics from acute through to rehabilitation settings are needed.
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Affiliation(s)
- Melissa Gaitan
- a School of Physiotherapy, Faculty of Health Sciences , Curtin University , Perth , Australia
| | - Liz Bainbridge
- a School of Physiotherapy, Faculty of Health Sciences , Curtin University , Perth , Australia
| | - Stephanie Parkinson
- a School of Physiotherapy, Faculty of Health Sciences , Curtin University , Perth , Australia
| | - Leanne Cormack
- b Department of Physiotherapy, Sir Charles Gairdner Hospital , Perth , Australia
| | - Sarah Cleary
- b Department of Physiotherapy, Sir Charles Gairdner Hospital , Perth , Australia
| | - Meg Harrold
- a School of Physiotherapy, Faculty of Health Sciences , Curtin University , Perth , Australia
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Huang YC, Chuang CY, Leong CP, Wang L, Chen HL, Chiang CW. Effect of Comprehensive Postural Instructions and Range of Motion Exercises Via Educational Videos on Motor Function and Shoulder Injury in Stroke Patients With Hemiplegia: A Preliminary Study. J Manipulative Physiol Ther 2018; 41:665-671. [PMID: 30567627 DOI: 10.1016/j.jmpt.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 09/06/2017] [Accepted: 03/27/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of comprehensive postural instructions and range of motion (ROM) exercises via educational videos for shoulder injury prevention and functional improvement of the hemiplegic shoulder after acute stroke. METHODS In this prospective cohort study, 48 subacute stroke patients with hemiplegia were enrolled and divided into 2 groups (23 in experimental group and 25 in control group). In the control group (n = 25), the patients performed conventional rehabilitation for 5 days per week. In the experimental group (n = 23), the patients received not only conventional rehabilitation but also additional postural instructions and regular ROM exercises via educational videos for hemiplegic shoulders for 15 minutes twice per day for 5 days per week during their hospital stay. Main outcome measures, including the presence and severity of pain, motor function, and sonography on hemiplegic shoulder, were assessed. RESULTS More motor recovery improvement was found in the experimental group (P < .05). In the supraspinatus tendon, a significantly increased frequency in tendinopathy or tear was observed between admission (12%) and before discharge (40%) in the control group (P < .05), but no difference was observed in the experimental group. In the subdeltoid bursa, effusion or bursitis was significantly reduced between admission (30.4%) and before discharge (8.7%) in the experimental group (P < .05). CONCLUSION These findings suggest that comprehensive postural instructions and ROM exercises via educational videos during inpatient rehabilitation for subacute stroke patients could improve motor recovery and limit shoulder injury in stroke patients with hemiplegia.
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Affiliation(s)
- Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan; Chang Gung University College of Medicine, Kaohsiung City, Taiwan.
| | - Chien-Yi Chuang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Chau-Peng Leong
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan; Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Ling Wang
- Pediatric Department, Pojen Hospital, Kaohsiung City, Taiwan
| | - Hsiao-Lan Chen
- Department of Physical Medicine and Rehabilitation, E-Da Hospital, Kaohsiung City, Taiwan
| | - Chia-Wei Chiang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
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10
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The Effect of Kinesiology Taping on the Hemiplegic Shoulder Pain: A Randomized Controlled Trial. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:8346432. [PMID: 30651946 PMCID: PMC6311752 DOI: 10.1155/2018/8346432] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/11/2018] [Indexed: 02/05/2023]
Abstract
Objective The purpose of the study was to explore the effect of kinesiology taping on hemiplegic shoulder pain (HSP) in terms of pain intensity, magnitude of subluxation, muscle activity, and active range of motion (AROM). Design Double-blind, placebo-controlled clinical trial. Setting the Rehabilitation Center of the West China Hospital. Participants Nineteen individuals suffering from HSP were recruited in this study. Intervention Patients were randomly assigned into the taping group or control group. The taping group received therapeutic kinesiology taping and conventional treatment, while the control group received placebo taping (applied without tension) and conventional treatment. Main Outcome Measures The shoulder pain intensity (numerical pain rating scale), magnitude of subluxation, muscle activity (measured by surface electromyography (sEMG)), and shoulder active range of movement (AROM) were assessed at the baseline, on the first day (immediately after taping) and 4 weeks after treatment (without taping). Results All patients completed the trials. There were no significant differences between groups at the baseline. The taping group showed immediate improvement on the first day after taping in terms of pain intensity, magnitude of subluxation, and muscle activity (p < 0.05), whereas no significant changes seen in the control group (p > 0.05). After 4 weeks of treatment, the taping group showed significant changes in pain intensity, magnitude of subluxation, muscle activity, and AROM (p < 0.05). And significant differences in pain intensity and muscle activity could be seen between the two groups (p < 0.05). Conclusion The results indicate that the kinesiology taping is effective in reducing the shoulder pain and subluxation and increasing muscle activity and AROM for patients with HSP after stroke.
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11
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Comley-White N, Mudzi W, Musenge E. Effects of shoulder strapping in patients with stroke: A randomised control trial. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2018; 74:430. [PMID: 30214946 PMCID: PMC6131703 DOI: 10.4102/sajp.v74i1.430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/23/2018] [Indexed: 11/09/2022] Open
Abstract
Background Disability post stroke remains a global problem, with upper limb involvement playing a key role. Shoulder strapping is one of the techniques used clinically to address this. Objectives To compare the effect of two shoulder strapping techniques in patients with stroke. Method A longitudinal randomised controlled trial included baseline, weeks one, two and six assessments of 56 participants with upper limb hemiplegia. The participants were assessed for shoulder subluxation, shoulder pain, upper limb motor function and muscle tone. They were randomised into control, longitudinal strapping or circumferential strapping groups. Results Longitudinal strapping had a non-significant decrease in shoulder subluxation and pain (p > 0.05). Circumferential strapping had no significant effect on any outcomes; however, it prevented the shoulder pain from worsening as much as in the control group (p > 0.05). General improvement in upper limb motor function was observed for all three groups. Conclusion Trends in improvement showed that longitudinal strapping could be recommended because it positively influenced shoulder subluxation and pain. Even without significant changes, strapping creates awareness of the limb in patients and caregivers and could be of clinical benefit. Clinical implication Longitudinal strapping of the shoulder in patients with stroke seems to positively influence shoulder subluxation and pain.
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Affiliation(s)
- Nicolette Comley-White
- Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, South Africa
| | - Witness Mudzi
- Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, South Africa
| | - Eustasius Musenge
- School of Public Health, University of the Witwatersrand, South Africa
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Ada L, Preston E, Langhammer B, Canning CG. Profile of upper limb recovery and development of secondary impairments in patients after stroke with a disabled upper limb: An observational study. Physiother Theory Pract 2018; 36:196-202. [DOI: 10.1080/09593985.2018.1482584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Louise Ada
- Faculty of Health Sciences, Discipline of Physiotherapy, University of Sydney, Cumberland Campus C42, Sydney, Australia
| | - Elisabeth Preston
- Faculty of Health Sciences, Discipline of Physiotherapy, University of Canberra, Canberra, Australia
| | | | - Colleen G Canning
- Faculty of Health Sciences, Discipline of Physiotherapy, University of Sydney, Cumberland Campus C42, Sydney, Australia
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Kashi Y, Ratmansky M, Defrin R. Deficient Pain Modulation in Patients with Chronic Hemiplegic Shoulder Pain. Pain Pract 2018; 18:716-728. [DOI: 10.1111/papr.12658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/14/2017] [Accepted: 11/08/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Yafit Kashi
- Department of Physical Therapy; Loewenstein Rehabilitation Hospital; Raanana Israel
- Department of Physical Therapy; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Motti Ratmansky
- Department of Physical Therapy; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
- Pain Rehabilitation Unit; Loewenstein Rehabilitation Hospital; Raanana Israel
| | - Ruth Defrin
- Department of Physical Therapy; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
- Sagol School of Neuroscience; Tel-Aviv University; Tel-Aviv Israel
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14
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Liang CM, Peng W, Ma XJ. Acupuncture for post-stroke upper limb pain. Hippokratia 2017. [DOI: 10.1002/14651858.cd009087.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Cui-mei Liang
- Guang An Men Hospital, China Academy of Chinese Medical Sciences; Department of Acupuncture and Moxibustion; No. 5, Bei Xian Ge Street, Xuanwu district Beijing China 100053
| | - Weina Peng
- Guang An Men Hospital, China Academy of Chinese Medical Sciences; Department of Acupuncture and Moxibustion; No. 5, Bei Xian Ge Street, Xuanwu district Beijing China 100053
| | - Xiao Jing Ma
- Guang An Men Hospital, China Academy of Chinese Medical Sciences; Department of Acupuncture and Moxibustion; No. 5, Bei Xian Ge Street, Xuanwu district Beijing China 100053
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Renzenbrink GJ, IJzerman MJ. Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life. Clin Rehabil 2016; 18:359-65. [PMID: 15180118 DOI: 10.1191/0269215504cr759oa] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the effect of percutaneous neuromuscular electrical stimulation (P-NMES) of the shoulder muscles on shoulder pain intensity and health-related quality of life in chronic hemiplegia. Design: Prospective, open label design. Setting: The outpatient services of a large teaching rehabilitation hospital in the Netherlands. Subjects: Fifteen stroke survivors with chronic (> six months) hemiplegia and a therapy-resistant painful shoulder with subluxation. All patients suffered from clinically relevant shoulder pain, as assessed by a score of at least 4 out of 10 on a numerical rating scale. Shoulder subluxation was indicated by at least 1/2 fingerbreadth of glenohumeral separation on palpation. Intervention: Six hours of P-NMES per day for a total of six weeks. Main outcome measures: Shoulder pain (Brief Pain Inventory), shoulder subluxation (clinical and radiographic), shoulder pain-free external rotation (hand-held goniometer), motor impairment (Fugl-Meyer Motor test) and quality of life (SF-36) were assessed before treatment, after six weeks of intramuscular stimulation, at three months and six months follow-up. Results: A significant reduction in pain was found on the Brief Pain Inventory. Pain reduction was still present at six months follow-up. All domains, in particular bodily pain, of the SF-36 showed improvement in the short term. After six months of follow-up, bodily pain was still strongly and significantly reduced, whereas social functioning and role physical demonstrated a nonsignificant improvement of more than 10% compared with baseline. Conclusion: This pilot suggests that P-NMES potentially reduces shoulder pain in chronic hemiplegia. To establish the clinical value of P-NMES in treating hemiplegic shoulder pain a randomized controlled trial is needed.
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Affiliation(s)
- Gerbert J Renzenbrink
- Roessingh Research and Development and Rehabilitation centre Het Roessingh, Enschede, The Netherlands.
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16
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Shepherd RB, Carr JH. The Shoulder following Stroke: Preserving Musculoskeletal Integrity for Function. Top Stroke Rehabil 2015. [DOI: 10.1310/u7qr-a17d-16xr-5gbt] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Effect of Interferential Current Stimulation in Management of Hemiplegic Shoulder Pain. Arch Phys Med Rehabil 2014; 95:1441-6. [DOI: 10.1016/j.apmr.2014.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/18/2014] [Accepted: 04/04/2014] [Indexed: 11/15/2022]
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The effect of ouhyul herbal acupuncture point injections on shoulder pain after stroke. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:504686. [PMID: 23843875 PMCID: PMC3697148 DOI: 10.1155/2013/504686] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 05/20/2013] [Accepted: 05/21/2013] [Indexed: 11/17/2022]
Abstract
An effective and safe remedy for shoulder pain is needed as shoulder pain is a common complication of stroke and restricts recovery of patients. This study was carried out to evaluate the effect of Ouhyul herbal acupuncture point injection (O-API) on shoulder pain in patients with stroke. Twenty-four participants with shoulder pain after stroke were recruited and randomized to the O-API and control groups. Treatment was conducted for 2 weeks three times per week. We evaluated the effects of treatment with a numerical rating scale (NRS), painless passive range of motion (PROM) of external shoulder rotation, and the Fugl-Meyer Motor Assessment (FMMA) at baseline, each week, and 1 week after the final treatment. All measures were similar between the O-API and control groups at baseline. The O-API group showed significant improvement on the NRS compared with that in the control group after 2 weeks of treatment, and the treatment effect was maintained until the follow-up period. PROM decreased significantly in both groups, but the reduction was maintained only in the O-API group. No significant difference was observed on the FMMA between the two groups. O-API resulted in significant improvement in shoulder pain after stroke, and its effect was maintained after termination of treatment without any severe side effects.
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Zeilig G, Rivel M, Weingarden H, Gaidoukov E, Defrin R. Hemiplegic shoulder pain: Evidence of a neuropathic origin. Pain 2013; 154:263-271. [DOI: 10.1016/j.pain.2012.10.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 10/15/2012] [Accepted: 10/30/2012] [Indexed: 11/30/2022]
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Stolzenberg D, Siu G, Cruz E. Current and future interventions for glenohumeral subluxation in hemiplegia secondary to stroke. Top Stroke Rehabil 2012; 19:444-56. [PMID: 22982832 DOI: 10.1310/tsr1905-444] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Poststroke shoulder pain is a common issue and can be caused by glenohumeral subluxation. This entity hinders function and quality of life and is caused by changes in tone and loss of fi ne control of the shoulder joints' supporting structures after a stroke. Current treatments are limited in number and effectiveness and have significant problems and limitations to their use. Furthermore, prior to percutaneous implantable neuromuscular electrical stimulation, there was no evidence for any treatment to provide relief for chronic hemiplegic shoulder pain from glenohumeral subluxation. This clinical review provides a comprehensive review of the anatomy, pathogenesis, clinical features, management, and clinical efficacy of current treatment modalities.
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Affiliation(s)
- David Stolzenberg
- Department of Physical Medicine and Rehabilitation, Temple University Hospital/ MossRehab, Philadelphia, Pennsylvania
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22
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Murie-Fernández M, Carmona Iragui M, Gnanakumar V, Meyer M, Foley N, Teasell R. Painful hemiplegic shoulder in stroke patients: Causes and management. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2012.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Coupar F, Pollock A, Rowe P, Weir C, Langhorne P. Predictors of upper limb recovery after stroke: a systematic review and meta-analysis. Clin Rehabil 2011; 26:291-313. [PMID: 22023891 DOI: 10.1177/0269215511420305] [Citation(s) in RCA: 243] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically review and summarize the current available literature on prognostic variables relating to upper limb recovery following stroke. To identify which, if any variables predict upper limb recovery following stroke. DATA SOURCES We completed searches in MEDLINE, EMBASE, AMED, CINAHL and Cochrane CENTRAL databases. Searches were completed in November 2010. REVIEW METHODS Studies were included if predictor variables were measured at baseline and linked to an outcome of upper limb recovery at a future time point. Exclusion criteria included predictor variables relating to response to treatment and outcome measurements of very specific upper limb impairments such as spasticity or pain. Two independent reviewers completed data extraction and assessed study quality. RESULTS Fifty-eight studies met the inclusion criteria. Predictor variables which have been considered within these studies include; age, sex, lesion site, initial motor impairment, motor-evoked potentials and somatosensory-evoked potentials. Initial measures of upper limb impairment and function were found to be the most significant predictors of upper limb recovery; odds ratio 14.84 (95% confidence intervals (CI) 9.08-24.25) and 38.62 (95% CI 8.40-177.53), respectively. CONCLUSIONS Interpretation of these results is complicated by methodological factors including variations in study populations, upper limb motor outcome scales, timing of baseline and outcome assessments and predictors selected. The most important predictive factors for upper limb recovery following stroke appears to the initial severity of motor impairment or function.
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Affiliation(s)
- Fiona Coupar
- Glasgow University, Academic Section of Geriatric Medicine, Glasgow, UK.
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Scapular and humeral movement patterns of people with stroke during range-of-motion exercises. J Neurol Phys Ther 2011; 35:18-25. [PMID: 21475080 DOI: 10.1097/npt.0b013e318208efa1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE In people with stroke, range-of-motion (ROM) exercises may contribute to hemiparetic shoulder pain, but the underlying mechanisms are unknown. This study examined scapular and humeral movement patterns in people with poststroke hemiparesis as they performed commonly prescribed ROM exercises. METHODS Using kinematic techniques, we studied 13 people with hemiparesis, both with and without pain, as they performed 3 commonly prescribed ROM exercises: person-assisted ROM, self-assisted ROM, and cane-assisted ROM. Their data were compared with those of a group of 12 matched control subjects performing scapular plane shoulder elevation, using mixed-model ANOVAs. Correlation analyses were used to examine the relationship between participants' ratings of pain and kinematic data. RESULTS The hemiparetic group had mild pain at rest that increased during the performance of the exercises. During shoulder elevation, humeral external rotation in the hemiparetic group was decreased in all 3 ROM exercises compared with that in the control group. Scapular upward rotation in the hemiparetic group was decreased for the person-assisted ROM exercise only. No differences in scapular tilt were found between groups. The extent of movement abnormalities was not related to pain severity. DISCUSSION AND CONCLUSIONS People with hemiparesis had altered scapular and humeral movement patterns and increased shoulder pain when performing the ROM exercises. These data can assist clinicians in making decisions regarding which exercises to prescribe to preserve shoulder motion and prevent contractures in this population.
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Murie-Fernández M, Carmona Iragui M, Gnanakumar V, Meyer M, Foley N, Teasell R. [Painful hemiplegic shoulder in stroke patients: causes and management]. Neurologia 2011; 27:234-44. [PMID: 21514698 DOI: 10.1016/j.nrl.2011.02.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 02/15/2011] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION The hemiplegic shoulder pain is common after a stroke. Its appearance brings pain and limits daily living activities as well as participation in specific Neuro-rehabilitation programs. All this leads to a worse functional outcome. Good management of patients can reduce both the frequency and intensity of shoulder pain, improving functional outcome. DEVELOPMENT We conducted a literature search of various databases between 1980 and 2008. The articles were evaluated using the PEDro scoring system. Five evidence levels were established for the conclusions. CONCLUSIONS Shoulder subluxation, occurs at an early stage after stroke and is associated with subluxation of the shoulder joint and spasticity (mainly subscapularis and pectoralis). Slings prevent subluxation of the shoulder. It is preferable to move within a lower range of motion and without aggression to prevent the occurrence of shoulder pain. The injection of corticosteroids does not improve pain and range of motion in hemiplegic patients, while botulinum toxin combined with physical therapy appears to reduce hemiplegic shoulder pain.
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Affiliation(s)
- M Murie-Fernández
- Departamento de Neurología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, España.
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Hardwick DD, Lang CE. Scapula and humeral movement patterns and their relationship with pain: a preliminary investigation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011; 18:210-220. [DOI: 10.12968/ijtr.2011.18.4.210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Catherine E Lang
- Occupational Therapy, and Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
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Yasar E, Vural D, Safaz I, Balaban B, Yilmaz B, Goktepe AS, Alaca R. Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial. Clin Rehabil 2010; 25:60-8. [DOI: 10.1177/0269215510380827] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To determine which injection technique was effective for patients with hemiplegic shoulder pain. Design: Randomized prospective double-blind study. Setting: Brain Injury Rehabilitation Unit. Intervention: Patients with hemiplegic shoulder pain were recruited over a 12-month period and all were hospitalized in our clinic. Intra-articular steroid injection or suprascapular nerve block was performed on all patients. Main measures: Range of motion values at the moment that pain started (range of motion A) and passive maximum range of motion values (range of motion B) were recorded. Pain intensity levels (visual analogue scale) at these two range of motion values (pain A and pain B) were also taken. Evaluations were made before the injection, and 1 hour, one week and one month after the injection. Results: Twenty-six patients were enrolled in the study, the mean age was 61.53 ± 10.30 years. The mean time since injury was 8.69 ± 15.71 months. The aetiology was ischaemic in 16 (61%) patients. Intra-articular steroid injection was performed in 11 (42 %) patients, and suprascapular nerve block in 15 (57%) patients. Range of motion A and range of motion B were changed statistically in repeated measures. There were important differences in repeated measures of pain intensity levels at these two range of motion values ( P < 0.05). However, no significant differences were determined in all measurements between intra-articular steroid injection and suprascapular nerve block groups ( P > 0.05). Conclusions: Our results showed that neither injection technique was superior to the other. Both injection procedures are safe and have a similar effect in stroke patients with hemiplegic shoulder pain.
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Affiliation(s)
- Evren Yasar
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Dilek Vural
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Ismail Safaz
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Birol Balaban
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Bilge Yilmaz
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Ahmet Salim Goktepe
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Ridvan Alaca
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
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English C, Hillier S, Stiller K. Incidence and severity of shoulder pain does not increase with the use of circuit class therapy during inpatient stroke rehabilitation: a controlled trial. ACTA ACUST UNITED AC 2008; 54:41-6. [PMID: 18298358 DOI: 10.1016/s0004-9514(08)70065-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
QUESTIONS Does circuit class therapy result in a greater incidence or severity of shoulder pain compared with individual therapy? Is the incidence influenced by the degree of active shoulder control? DESIGN Controlled trial with intention-to-treat analysis. PARTICIPANTS Sixty-eight people (6 drop-outs) undergoing inpatient rehabilitation after stroke. INTERVENTION Participants received either individual therapy or group circuit class therapy. OUTCOME MEASURES Incidence of shoulder pain over the previous 24 hours was measured as a yes/no response while severity of shoulder pain was measured using a visual analogue scale at admission, Week 4, and discharge. RESULTS There was no greater chance of participants receiving circuit class therapy having shoulder pain at Week 4 (OR 0.95, 95% CI 0.32 to 2.80) or discharge (OR 0.38, 95% CI 0.11 to 1.45) than participants receiving individual therapy. Of those participants who reported pain, there was no difference between groups in the severity of pain at Week 4 (mean difference -0.2 cm, 95% CI -3.2 to 2.7) or discharge (mean difference -2.1 cm, 95% CI -4.8 to 0.6). There was a greater chance of participants who had no active shoulder control having shoulder pain at Week 4 (OR 5.8, 95% CI 1.6 to 20.4) and at discharge (OR 3.8, 95% CI 1.0 to 13.9) than participants who had active shoulder control. CONCLUSION The incidence and severity of shoulder pain was influenced by degree of active shoulder control but not by type of physiotherapy service delivery. Concerns regarding shoulder pain should not be a barrier to the implementation of circuit class therapy during inpatient stroke rehabilitation.
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Affiliation(s)
- Coralie English
- University of South Australia, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia.
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Rajaratnam BS, Venketasubramanian N, Kumar PV, Goh JC, Chan YH. Predictability of Simple Clinical Tests to Identify Shoulder Pain After Stroke. Arch Phys Med Rehabil 2007; 88:1016-21. [PMID: 17678664 DOI: 10.1016/j.apmr.2007.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify simple diagnostic musculoskeletal tests that can be performed early after stroke to predict patients' likelihood of reporting early signs of hemiplegic shoulder pain. DESIGN Case control. SETTING Multicenter acute care hospitals. PARTICIPANTS A total of 152 adults after a first episode of stroke, of whom 135 met the inclusion criteria. Thirty patients were assigned to the experimental group because they reported moderate intensity of hemiplegic shoulder pain at rest. The remaining 105 patients made up the control group. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Therapists measured the performance of combined upper-limb movement including the hand-behind-neck (HBN) maneuver, passive pain-free ranges of shoulder motion, 3 musculoskeletal tests, and the strength of deltoid muscles during each patient's hospital stay. The numeric rating scale (NRS) identified those who reported moderate or greater intensities of hemiplegic shoulder pain during rest and during assessment. RESULTS In our study, 22.2% (95% confidence interval, 15.5-30.2) of the patients reported hemiplegic shoulder pain, on average 1 week after the onset of stroke. Positive Neer test (NRS score >or=5) during the HBN maneuver and a difference of more than 10 degrees of passive range of external rotation between shoulders had a 98% probability of predicting the presence of hemiplegic shoulder pain (receiver operating characteristic, .994; sensitivity, 96.7%; specificity, 99.0%; positive predictive value, 96.7%; negative predictive value, 99.0%; P<.001). CONCLUSIONS Three diagnostic clinical tests that can be performed during a bedside evaluation increase the likelihood of determining those who complain of hemiplegic shoulder pain after an acute episode of stroke.
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Paci M, Nannetti L, Taiti P, Baccini M, Rinaldi L. Shoulder subluxation after stroke: relationships with pain and motor recovery. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2007; 12:95-104. [PMID: 17536647 DOI: 10.1002/pri.349] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Glenohumeral subluxation (GHS) is a frequent complication in patients with post-stroke hemiplegia, but its role in functional recovery is still unclear. The aim of the present investigation was to understand the relationship of GHS with shoulder pain and arm motor recovery. METHOD A case-control study design was used. A sample of 107 hemiplegic adults with recent stroke (less than 30 days from onset) was differentiated into two groups according to the presence of GHS. Motor recovery was assessed using the upper extremity part of the Fugl-Meyer Assessment Scale and the presence of shoulder pain was recorded at admission (T1), at discharge (T2) and at follow-up, 30-40 days after discharge (T3). RESULTS GHS was present in 52 patients (48.6%) and correlated significantly to shoulder pain at TI, at T2 and at T3 (p < 0.001). Moreover, GHS at admission accounted for nearly 50% of shoulder pain at T3 (adjusted R2 = 0.458; p < 0.001). The presence of GHS was independently associated with the upper extremity score of the Fugl-Meyer Assessment Scale at follow-up (adjusted R2 = 0.766; p < 0.001). CONCLUSIONS GHS is a factor associated with shoulder pain development and with arm motor recovery and should be treated in the acute stage of hemiplegia.
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Affiliation(s)
- Matteo Paci
- Department of Rehabilitation Medicine, Prato Hospital, Prato, Italy.
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Nicks RJ, DeGruyter MA, Walkenhorst-Maccanti H, Bernhardt J. Changing practice for acute hemiplegic shoulder care: A best practice model. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2007. [DOI: 10.12968/ijtr.2007.14.6.23896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rebecca J Nicks
- Allied Health – Neurosciences, The Royal Melbourne Hospital, Melbourne, Australia
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Abstract
BACKGROUND AND PURPOSE Shoulder pain is a well-known complication after stroke, but data on prevalence, predictors, and outcome in unselected stroke populations are limited. METHODS During a 1-year period, 416 first-ever stroke patients were included in the population-based Lund Stroke Register. After 4 months, 327 patients were followed up and 1 year later, the surviving 305 patients were followed up again. General status (National Institutes of Health Stroke Scale score) was registered at stroke onset. Shoulder pain intensity (visual analog scale, score 0 to 30=no-mild and 40 to 100=moderate-severe pain); arm motor function; restricted dressing and/or ambulating; and functional status (Barthel Index) were registered at both follow ups. RESULTS Shoulder pain onset within 4 months after stroke was reported by 71 patients (22%). Among the 61 patients able to score the visual analog scale, 79% had moderate-severe pain. One year later, 8 of these 71 patients had died, 17 had no remaining pain, and 28 additional patients had developed shoulder pain since the first follow up. Lost or impaired arm motor function and high National Institutes of Health Stroke Scale score were predictors of shoulder pain. Shoulder pain restricted daily life often or constantly when dressing for 51%/31% and when ambulating for 29%/13% of the patients at 4 and 16 months, respectively. CONCLUSIONS Almost one third of the 327 patients developed shoulder pain after stroke onset, a majority with moderate- severe pain. Shoulder pain restricts patients' daily life after stroke. The increased risk of shoulder pain for patients with impaired arm motor function and/or low general status needs close attention in poststroke care.
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Affiliation(s)
- Ingrid Lindgren
- Department of Neurology, Clinical Sciences, Lund University, Lund, Sweden.
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Van Til JA, Renzenbrink GJ, Groothuis K, Ijzerman MJ. A preliminary economic evaluation of percutaneous neuromuscular electrical stimulation in the treatment of hemiplegic shoulder pain. Disabil Rehabil 2006; 28:645-51. [PMID: 16690578 DOI: 10.1080/09638280500277057] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of this study was to compare the cost-effectiveness of various treatment modalities for hemiplegic shoulder pain. DESIGN A stage II economic evaluation. MAIN OUTCOME MEASURES Incremental cost effectiveness ratio of P-NMES, compared to slings and anti-inflammatory injections. RESULTS The incremental cost effectiveness ratio (ICER) of p-NMES, compared to anti-inflammatory injections is 6,061 euro(+/-3,285). The incremental cost of the first quality-adjusted life year after implantation of the P-NMES device compared to anti-inflammatory injections is 33,007 euro (+/-5,434). This decreases to approximately 7,000 euro after 5 years, and to approximately 5,000 euro after 10 survival years. CONCLUSION In this early evaluation, P-NMES seems to be cost-effective according to known guidelines. Treatment with P-NMES is recommended for patients with chronic HSP.
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Abstract
Stroke is an increasing public health concern throughout the world as the leading cause of long-term disability. It is well known that there exist differences related to epidemiology, pathophysiology, comorbidity, and functional outcome of stroke patients with advanced age compared with the young. Factors that have been suggested to influence this disparity include age-related complications, availability of resources, lack of aggressive management, and possible diminished capacity for neuroplasticity. This article reviews the current medical and rehabilitative aspects of stroke and the possible disparities related to advanced age.
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Affiliation(s)
- Monika V Shah
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, and Long-Term Acute Care Brain Injury Program, Kindred Hospital, 1333 Moursund Avenue, D-111, Houston, TX 77030, USA.
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Abstract
OBJECTIVE Shoulder pain is a common complication after stroke that can limit the patients' ability to reach their maximum functional potential and impede rehabilitation. The aim of our study was to examine the occurrence of hemiplegic shoulder pain in a group of Turkish patients and clarify contributing factors such as glenohumeral subluxation, reflex sympathetic dystrophy, tonus changes, motor functional level, limitation in shoulder range of motion, thalamic pain, neglect, and time since onset of hemiplegia. The effect of shoulder pain on the duration of rehabilitation stay was also identified. DESIGN A total of 85 consecutive patients with hemiplegia admitted to a national rehabilitation center were evaluated for the presence of shoulder pain. A brief history of pain was taken for each patient, and each patient was evaluated by radiographic and ultrasonographic examination. The subjects with shoulder pain were compared with those without pain in regard to certain of the above variables. RESULTS Of the 85 patients with stroke, 54 patients (54/85, 63.5%) were found to have shoulder pain. Shoulder pain was significantly more frequent in subjects with reflex sympathetic dystrophy, lower motor functional level of shoulder and hand (P < 0001), subluxation, and limitation of external rotation and flexion of shoulder (P < 0,05). Age was also a significant factor in the development of shoulder pain. We were unable to demonstrate a significant relationship between shoulder pain and sex, time since onset of disease, hemiplegic side, pathogenesis, spasticity, neglect, and thalamic pain. There was no prolongation of rehabilitation stay in patients with shoulder pain. CONCLUSION These results indicate that shoulder pain is a frequent complication after stroke and that it may develop from a variety of factors. To prevent and alleviate shoulder pain, efforts should be directed toward proper positioning of the shoulder, range of motion activities, and the avoidance of immobilization.
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Affiliation(s)
- Meltem Dalyan Aras
- Department of Physical Medicine, Ankara Physical Medicine and Rehabilitation, Education, and Research Hospital, Turkey
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Salisbury SK, Choy NL, Nitz J. Shoulder pain, range of motion, and functional motor skills after acute tetraplegia11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2003; 84:1480-5. [PMID: 14586915 DOI: 10.1016/s0003-9993(03)00371-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate (1) the prevalence and course of shoulder pain in acute tetraplegia and (2) its relationship with range of motion (ROM) and function and any associated risk factors. DESIGN A longitudinal prospective study. SETTING Spinal injury unit in an Australian hospital. PARTICIPANTS Inpatients with acute tetraplegia. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Demographics, pain intensity, shoulder ROM, and functional motor skills. RESULTS The prevalence of pain during rehabilitation was 85%. Risk factors associated with pain during rehabilitation included age less than 30 years or more than 50 years (F=8.892, P=.064), admission motor level at C2-5 (F=5.833, P=.016), admission sensory level at C2-5 (F=7.543, P=.006), lower left upper limb (P=.005; 95% confidence interval [CI], -14.74 to -2.86) and total American Spinal Injury Association motor scores (P=.009; 95% CI, -29.53 to -4.67), and a shorter duration of bedrest (F=5.794, P=.055). Subjects with pain lost ROM in left abduction (P=.038; 95% CI, -25.9 to -0.9) and right abduction (P=.05; 95% CI, -30 to 9.3). No relationship existed between shoulder pain and functional motor skills on discharge. CONCLUSION Shoulder pain is common in acute tetraplegia and is associated with loss of shoulder ROM. Risk factors identified include age, injury level, and duration of bedrest. Areas for further study are identified.
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Affiliation(s)
- Susan K Salisbury
- Department of Physiotherapy, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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Ratnasabapathy Y, Broad J, Baskett J, Pledger M, Marshall J, Bonita R. Shoulder pain in people with a stroke: a population-based study. Clin Rehabil 2003; 17:304-11. [PMID: 12735538 DOI: 10.1191/0269215503cr612oa] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To measure the occurrence of shoulder pain after stroke. To identify the factors that predict risk of shoulder pain after stroke. DESIGN Auckland Stroke Study, population-based case-cohort study. SETTING AND SUBJECTS All cases of stroke, including those managed outside hospital, over a 12-month period ending February 1992 were considered in Auckland. OUTCOME MEASURES Self-reported shoulder pain at one week, one month and six months after the onset of stroke for each person. RESULTS A total of 1,761 stroke events were identified. Self-reported shoulder pain among survivors increased from 256/1474 (17%) at one week, to 261/1,336 (20%) at one month and 284/1,201 (23%) at six months. Shoulder pain was positively associated with motor deficit, side of deficit and severity of deficit. In those surviving to six months after stroke, the risk of shoulder pain was higher in those with severe upper limb motor deficit (odds ratio (OR) 4.94; 95% confidence interval (CI) 3.06-7.98) and in diabetics (OR 1.57, 95% CI 1.15-2.14). Risk of shoulder pain increased with time and was lower for those in institutional care. CONCLUSION Shoulder pain after stroke is common, especially in patients with severe sensorimotor deficits, diabetics and those living at home. Appropriate management may reduce the rate of occurrence.
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Turner-Stokes L, Rusconi S. Screening for ability to complete a questionnaire: a preliminary evaluation of the AbilityQ and ShoulderQ for assessing shoulder pain in stroke patients. Clin Rehabil 2003; 17:150-7. [PMID: 12625655 DOI: 10.1191/0269215503cr595oa] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess the repeatability of the AbilityQ--a screening tool to assess technical ability to complete a questionnaire--in patients with complex disabilities following stroke. To evaluate the validity of the AbilityQ in predicting repeatability and consistency of response to verbal and visual analogue scale questions in the ShoulderQ in those with shoulder pain. DESIGN In a cross-sectional study, the AbilityQ and 'ShoulderQ' were administered on two consecutive days by a single investigator. SETTING Six regional rehabilitation centres in the UK managing patients with severe complex neurological disability. SUBJECTS Forty-nine patients with anterior or posterior circulation strokes: 13 (63%) had cognitive deficits and 28 (57%) had communicative deficits. RESULTS Thirty-one (63.3%) patients required some degree of help in completing the AbilityQ. Percentage agreement for individual questions between day 1 and day 2 ranged from 55 to 88% with kappa values from 0.07 to 0.79. Repeatability of ShoulderQ responses was 36-72% for the verbal questions (kappa values 0.16-0.56). For visual analogue scale (VAS) questions, agreement +/- 1 on a 10-point scale was 36-59% with intraclass correlation coefficients 0.50-0.60 (p < 0.01). High verbal (> or = 3/4) and VAS scores (3/3) on the AbilityQ had positive predictive values for good repeatability in the ShoulderQ of 80% and 58% respectively. Mismatched AbilityQ responses to verbal and VAS questions showed a positive predictive value of 92% for similar inconsistency in the ShoulderQ and a negative predictive value of 90%. CONCLUSIONS In this preliminary evaluation the AbilityQ and the ShoulderQ each demonstrated a moderate level of repeatability in a group of patients expected to have difficulty in completing questionnaires. The AbilityQ appears to have some clinical usefulness in identifying those able to respond to the ShoulderQ and, where responses to verbal and VAS questions conflict, may offer some guidance as to which are most likely to be accurate in that individual. Further development is underway.
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Affiliation(s)
- Lynne Turner-Stokes
- Regional Rehabilitation Unit, Northwick Park Hospital, Middlesex, London, UK
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Gamble GE, Barberan E, Laasch HU, Bowsher D, Tyrrell PJ, Jones AKP. Poststroke shoulder pain: a prospective study of the association and risk factors in 152 patients from a consecutive cohort of 205 patients presenting with stroke. Eur J Pain 2003; 6:467-74. [PMID: 12413435 DOI: 10.1016/s1090-3801(02)00055-1] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Shoulder pain is known to retard rehabilitation after stroke. Its causes and prognosis are uncertain. This study describes the incidence of poststroke shoulder pain prospectively, in an unselected stroke population in the first 6 months after stroke and identifies risk factors for developing pain. METHODS 297 patients with possible stroke were screened and stroke diagnosed in 205 cases. The 152 patients entered the study of which 123 patients were assessed up to 6 months. This cohort, with a mean age of 70.6 years, was examined at 2 weeks, 2, 4, and 6 months. A history of shoulder pain, Barthel score, anxiety and depression score were recorded. Full neurological and rheumatological examination was undertaken, using the contralateral side as a control. Pain outcome and stroke outcome was recorded at subsequent visits. RESULTS 52 (40%) patients developed shoulder pain on the same side of their stroke. There was a strong association between pain and abnormal shoulder joint examination, ipsilateral sensory abnormalities and arm weakness. Shoulder pain had resolved or improved at 6 months in 41 (80%) of the patients with standard current treatment. CONCLUSIONS Shoulder pain after stroke occurred in 40% of 123 patients surviving, consenting and not too unwell to participate. This included 52 patients of an original cohort of 205 patients presenting with stroke. Eighty percent of patients made a good recovery with standard treatment Patients with sensory and or motor deficits represent at risk sub-groups.
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Affiliation(s)
- Giles E Gamble
- Elderly Care Department, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK.
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Daviet JC, Salle JY, Borie MJ, Munoz M, Rebeyrotte I, Dudognon P. [Clinical factors associate with shoulder subluxation in stroke patients]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2002; 45:505-9. [PMID: 12495823 DOI: 10.1016/s0168-6054(02)00303-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study explores whether shoulder subluxation after stroke is related to age, hemiplegic side motor impairment, spasticity, sensory deficit, depression, unilateral neglect and length of stay in acute ward. METHOD This prospective study included 57 patients with hemiplegia. The shoulder subluxation was systematically detected by radiography and quantified according to de Bats score. The complete clinical assessment of the upper limb on day 15 analyzed motricity (motricity index), spasticity of shoulder adductors and biceps (Ashworth), sensory deficit, unilateral neglect and depression (MADRS). Age, side of hemiplegia and the aetiology were also noted. We researched relations between shoulder subluxation and these clinical factors. Means were compared using Mann Whitney and chi(2) tests. Coefficients of correlation were estimated between two quantitative variables. A multiple regression analysis was also conducted including all significant parameters, the dependent variable being the shoulder subluxation. RESULTS Shoulder subluxation was observed in 32% of hemiplegic patients. After multiple regression analysis, the main clinical factors related to subluxation were motor (p < 0.0001), spasticity of shoulder adductors (p = 0.028) and age (p = 0.036). Statistically, the risk of subluxation was divided by 1.62 (1.07, 2.43) for every five years age growth and by two (1.33, 2.94) when the motricity index went up by ten points. CONCLUSION This study shows that the age could play an independent part. The loss of elasticity of the periarticular tissues when ageing could have a protective role.
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Affiliation(s)
- J C Daviet
- Département de médecine physique et de réadaptation, hôpital J. Rebeyrol, CHU Dupuytren, 87042 Limoges cedex, France.
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Turner-Stokes L, Jackson D. Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway. Clin Rehabil 2002; 16:276-98. [PMID: 12017515 DOI: 10.1191/0269215502cr491oa] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Shoulder pain is a common complication of stroke. It can impede rehabilitation and has been associated with poorer outcomes and prolonged hospital stay. This systematic review was undertaken to inform the development of an evidence-based integrated care pathway (ICP) for the management of hemiplegic shoulder pain (HSP). AIMS AND OBJECTIVES 1) To provide a background understanding of the functional anatomy of the shoulder and its changes following stroke. 2) To review the literature describing incidence and causation of HSP and the evidence for factors contributing to its development. 3) To appraise the evidence for effectiveness of different interventions for HSP. METHODS Data sources comprised a computer-aided search of published studies on shoulder pain in stroke or hemiplegia and references to literature used in reviews (total references = 121). MAIN FINDINGS Although a complex variety of physical changes are associated with HSP, these broadly divide into 'flaccid' and 'spastic' presentations. Management should vary accordingly; each presentation requiring different approaches to handling, support and intervention. (1) In the flaccid stage, the shoulder is prone to inferior subluxation and vulnerable to soft-tissue damage. The arm should be supported at all times and functional electrical stimulation may reduce subluxation and enhance return of muscle activity. (2) In the spastic stage, movement is often severely limited. Relieving spasticity and maintaining range requires expert handling; overhead exercise pulleys should never be used. Local steroid injections should be avoided unless there is clear evidence of an inflammatory lesion. CONCLUSIONS HSP requires co-ordinated multidisciplinary management to minimize interference with rehabilitation and optimize outcome. Further research is needed to determine effective prophylaxis and document the therapeutic effect of different modalities in the various presentations. Development of an integrated care pathway provides a reasoned approach to management of this complex condition, thus providing a sound basis for prospective evaluation of different interventions in the future.
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Affiliation(s)
- Lynne Turner-Stokes
- Regional Rehabilitation Unit, Northwick Park and St Mark's Hospital Trust, Harrow, Middlesex, UK.
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Tyson SF, Chissim C. The immediate effect of handling technique on range of movement in the hemiplegic shoulder. Clin Rehabil 2002; 16:137-40. [PMID: 11911511 DOI: 10.1191/0269215502cr480oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE To assess the immediate effect of two different handling. techniques on range of flexion in the hemiplegic shoulder. METHOD A randomized controlled design with within-subject comparison was used. Range of shoulder flexion was measured using a bubble goniometer. Range of passive movement was compared as the weak arm was lifted using an 'axilla hold' (when the gleno-humeral joint is supported and held in external rotation) and a 'distal hold' (when the arm is lifted at the forearm without shoulder support). Twenty-two people with arm weakness following stroke were recruited. They were inpatients or attending a day hospital in two NHS trusts, with no previous limitation of range or function of their arm. A paired t-test was used for analysis. RESULTS Mean shoulder flexion for the axilla hold was 115.2 degrees (SD 38.45), and 97.7 degrees (SD 44.7) for the distal hold. This difference was significant at p < 0.001 (95% confidence interval (95% CI) 7.96, 26.88). CONCLUSIONS Lifting the hemiplegic arm by holding the humerus under the axilla and maintaining external rotation produces greater range of flexion at the hemiplegic shoulder than a 'distal hold'.
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Affiliation(s)
- S F Tyson
- Department of Health Studies, Brunel University, Middlesex, UK.
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Daviet JC, Preux PM, Salle JY, Lebreton F, Munoz M, Dudognon P, Pelissier J, Perrigot M. Clinical factors in the prognosis of complex regional pain syndrome type I after stroke: a prospective study. Am J Phys Med Rehabil 2002; 81:34-9. [PMID: 11807329 DOI: 10.1097/00002060-200201000-00006] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate clinical prognostic factors of complex regional pain syndrome type I (CRPS I) in patients with stroke in an attempt to improve the Perrigot score, which does not include shoulder subluxation, unilateral neglect, or depression. DESIGN This was a prospective study. The initial clinical data (first month) included motor index, Ashworth scale, de Bats score for shoulder subluxation, Montgomery-Asberg Depression Rating Scale, and sensory disorders evaluation. The prognosis of CRPS I was evaluated from the Perrigot score. A score of CRPS I severity was measured on entry and 3 mo later. RESULTS Of the 71 patients with hemiplegia who were included, 34.8% had a CRPS I. The five main clinical factors in the prognosis of CRPS I were motor deficit, spasticity, sensory deficits, and initial coma. The prognostic score of Perrigot was strongly correlated with the CRPS I severity and was predictive of subsequent progression. CONCLUSION Shoulder subluxation, unilateral neglect, and depression did not seem to be determinant predictive factors of CRPS I severity.
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Affiliation(s)
- Jean-Christophe Daviet
- Département de médecine physique et de réadaptation, CHU Dupuytren, rue Martin Luther King, 87042 Limoges cedex, France
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Kondo I, Hosokawa K, Soma M, Iwata M, Maltais D. Protocol to prevent shoulder-hand syndrome after stroke. Arch Phys Med Rehabil 2001; 82:1619-23. [PMID: 11689984 DOI: 10.1053/apmr.2001.25975] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the effectiveness of a protocol designed to restrict passive movement of affected upper extremity on the incidence of shoulder-hand syndrome (SHS) after stroke. DESIGN Before-and-after trial: follow-up duration of subject group and historical control group 231.6 and 257.2 days, respectively. SETTING Rehabilitation medicine department in a hospital in Japan. PARTICIPANTS SUBJECTS 81 stroke patients treated with the protocol from 1994 to 1996 who were followed for at least 4 months from the onset of stroke; controls: 71 stroke patients treated without the protocol from 1991 to 1994 who were followed for same length of time. INTERVENTION Use of a set protocol for controlled passive movement by trained therapists and restriction of passive movement by the patients for 4 months after stroke. The SHS criterion used to detect early signs of SHS has not yet been validated. Corticosteroids were given to all subjects diagnosed with SHS. MAIN OUTCOME MEASURES Swelling index, SHS diagnostic criteria applied in physical exam, Brunnstrom stage, and sensory disturbance evaluations. RESULT The incidence of SHS in the subject group was 18.5% (n = 15), whereas the incidence of SHS in the control group was 32.4% (n = 23). The difference between the 2 groups was statistically significant (chi(2) = 3.885, p < .05). CONCLUSION The protocol helped to prevent development of SHS.
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Affiliation(s)
- I Kondo
- Department of Rehabilitation Medicine, Institute of Brain Science, Hirosaki University, Japan.
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Daviet JC, Preux PM, Salle JY, Lebreton F, Munoz M, Dudognon P, Pelissier J, Perrigot M. [The shoulder-hand syndrome after stroke: clinical factors of severity and value of prognostic score of Perrigot]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2001; 44:326-32. [PMID: 11587674 DOI: 10.1016/s0168-6054(01)00109-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The purposes of this study were to evaluate the prognostical factors of reflex sympathetic dystrophy in stroke patients in attempt to improve the Perrigot prognostical score. MATERIAL AND METHOD This prospective study included 28 stroke patients with reflex sympathetic dystrophy. An initial clinical assessment including Perrigot score was made at the time of admission (before the end of the first month) and a second evaluation of reflex sympathetic dystrophy at the end of the third month. Patients were assessed using Motricity Index, Ashworth scale, de Bats grading (for glenohumeral alignment), Labrousse criteria (for reflex sympathetic dystrophy severity), and MADRS depression scale. Sensory deficit and unilateral neglect were noted. RESULTS The length of stay in acute ward was 16 days. The Perrigot score was correlated with the reflex sympathetic dystrophy severity (r = 0.7, p < 0.0001). It predicted the result of therapy. A significant correlation was found between reflex sympathetic dystrophy severity and motor deficit (r = -0.591, p = 0.0007) and spasticity (p < 0.05). No relation was found with stroke side, unilateral neglect, depression or shoulder subluxation. It wasn't possible to improve the Perrigot prognostical score. CONCLUSION Perrigot score predict reflex sympathetic dystrophy severity and the result of therapy. The shoulder subluxation which is not included in this score appears to be not predictive. Shoulder subluxation is simply a marker of a severe paresis.
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Affiliation(s)
- J C Daviet
- Département de médecine physique et de réadaptation, CHU Dupuytren, 2, avenue Martin Luther King, 87042 cedex, Limoges, France
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Price CI, Pandyan AD. Electrical stimulation for preventing and treating post-stroke shoulder pain: a systematic Cochrane review. Clin Rehabil 2001; 15:5-19. [PMID: 11237161 DOI: 10.1191/026921501670667822] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Shoulder pain after stroke is common and disabling. The optimal management is uncertain, but electrical stimulation (ES) is often used to treat and prevent pain. OBJECTIVES The objective of this review was to determine the efficacy of any form of surface ES in the prevention and/or treatment of pain around the shoulder at any time after stroke. SEARCH STRATEGY We searched the Cochrane Stroke Review Group trials register and undertook further searches of Medline, Embase and CINAHL. Contact was established with equipment manufacturers and centres that have published on the topic of ES. SELECTION CRITERIA We considered all randomized trials that assessed any surface ES technique (functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS) or other), applied at any time since stroke for the purpose of prevention or treatment of shoulder pain. DATA COLLECTION AND ANALYSIS Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data. MAIN RESULTS Four trials (a total of 170 subjects) fitted the inclusion criteria. Study design and ES technique varied considerably, often precluding the combination of studies. Population numbers were small. There was no significant change in pain incidence (odds ratio (OR) 0.64; 95% CI 0.19-2.14) or change in pain intensity (standardized mean difference (SMD) 0.13; 95% CI -1.0-1.25) after ES treatment compared with control. There was a significant treatment effect in favour of ES for improvement in pain-free range of passive humeral lateral rotation (weighted mean difference (WMD) 9.17; 95% CI 1.43-16.91). In these studies ES reduced the severity of glenohumeral subluxation (SMD -1.13; 95% CI -1.66 to -0.60), but there was no significant effect on upper limb motor recovery (SMD 0.24; 95% CI -0.14-0.62) or upper limb spasticity (WMD 0.05; 95% CI -0.28-0.37). There did not appear to be any negative effects of electrical stimulation at the shoulder. REVIEWERS' CONCLUSIONS The evidence from randomized controlled trials so far does not confirm or refute that ES around the shoulder after stroke influences reports of pain, but there do appear to be benefits for passive humeral lateral rotation. A possible mechanism is through the reduction of glenohumeral subluxation. Further studies are required.
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Affiliation(s)
- C I Price
- Geriatric Medicine, Newcastle University and Northumbria Healthcare NHS Trust, Newcastle upon Tyne, UK.
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Pomeroy VM, Niven DS, Barrow S, Faragher EB, Tallis RC. Unpacking the black box of nursing and therapy practice for post-stroke shoulder pain: a precursor to evaluation. Clin Rehabil 2001; 15:67-83. [PMID: 11237164 DOI: 10.1191/026921501675454995] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To describe current nursing and therapy interventions for the prevention and treatment of post-stroke shoulder pain and to explore the extent of their reported use in England. DESIGN Semi-structured, the med interviews followed by a postal questionnaire. PARTICIPANTS Six nurses, five occupational therapists (OTs) and six physiotherapists (PTs) were interviewed. Twelve nurses, 12 OTs and 12 PTs were sent the pilot questionnaire and the main questionnaire was posted to 332 nurses, 332 OTs and 332 PTs. SETTING NHS Trusts in England which provide acute stroke care/rehabilitation. PROCEDURE Two researchers independently condensed the transcripts of the interviews into a list of interventions which were then transformed into a pilot postal questionnaire. Following the pilot small changes were made. Participants sent the main questionnaire were given three weeks to return it before being posted a reminder. After a further two weeks a researcher gave a telephone reminder. RESULTS One hundred and seventy-five different types of interventions were identified. The main questionnaire (57.8% response rate) found that all of the interventions were used by at least one respondent and that only 22.9% of the interventions were used to the same extent by nurses, OTs and PTs. The data also suggest variation in reported use within professions. CONCLUSIONS This study has found a large number of interventions for post-stroke shoulder pain which are reported to be used. This might reflect different causes of shoulder pain or variation between clinicians. Answers to these questions are expected to guide future evaluative research.
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Affiliation(s)
- V M Pomeroy
- The Stroke Association's Therapy Research Unit, The University of Manchester, UK.
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Pomeroy VM, Frames C, Faragher EB, Hesketh A, Hill E, Watson P, Main CJ. Reliability of a measure of post-stroke shoulder pain in patients with and without aphasia and/or unilateral spatial neglect. Clin Rehabil 2000; 14:584-91. [PMID: 11128732 DOI: 10.1191/0269215500cr365oa] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the inter/intra-rater reliability of expert physiotherapists (PTs) measuring post-stroke shoulder pain with 100 mm vertical visual analogue scales (VAS; intensity, frequency and affective response) and a categorical site-of-pain scale. DESIGN Three PTs independently rated subjects (normal clinical procedure but with a standardized starting position) on three days, at the same time of day, during one week in a randomized order determined by a nested latin square. Reliability for VAS scores was determined with the intraclass correlation coefficient (ICC) and for site-of-pain with the kappa statistic (kappa). Acceptable reliability was set at 0.75. The limits of agreement were also calculated. SETTING Community. SUBJECTS Thirty-three patients, mean time post stroke 42 months (range 7-360). RESULTS Mean inter-rater reliability was 0.79 for intensity, 0.75 for frequency and 0.62 for affective response (ICC). The limits of agreement were wide and rater bias was significant for 6/27 ratings. Mean intra-rater reliability was 0.70 for intensity, 0.77 for frequency and 0.69 for affective response (ICC). For site-of-pain inter-rater reliability ranged from 0.156 (kappa) to 0.385 (kappa) and intrarater reliability ranged from 0.300 (kappa) to 0.559 (kappa). CONCLUSIONS Although inter-rater reliability was acceptable for intensity and frequency there was a consistently large systematic bias between pairs of raters. Agreement might be improved if a standardized assessment procedure was used and/or if training in pain behaviour interpretation was provided.
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Affiliation(s)
- V M Pomeroy
- The Stroke Association's Therapy Research Unit, The University of Manchester, Salford Royal Hospitals NHS Trust, UK.
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Price CI, Pandyan AD. Electrical stimulation for preventing and treating post-stroke shoulder pain. Cochrane Database Syst Rev 2000; 2000:CD001698. [PMID: 11034725 PMCID: PMC8406756 DOI: 10.1002/14651858.cd001698] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Shoulder pain after stroke is common and disabling. The optimal management is uncertain, but electrical stimulation (ES) is often used to treat and prevent pain. OBJECTIVES The objective of this review was to determine the efficacy of any form of surface ES in the prevention and / or treatment of pain around the shoulder at any time after stroke. SEARCH STRATEGY We searched the Cochrane Stroke Review Group trials register and undertook further searches of MEDLINE, EMBASE and CINAHL. Contact was established with equipment manufacturers and centres that have published on the topic of ES. SELECTION CRITERIA We considered all randomised trials that assessed any surface ES technique (functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS) or other), applied at any time since stroke for the purpose of prevention or treatment of shoulder pain. DATA COLLECTION AND ANALYSIS Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data. MAIN RESULTS Four trials (a total of 170 subjects) fitted the inclusion criteria. Study design and ES technique varied considerably, often precluding the combination of studies. Population numbers were small. There was no significant change in pain incidence (Odds Ratio (OR) 0.64; 95% CI 0.19 to 2.14) or change in pain intensity (Standardised Mean Difference (SMD) 0.13; 95% CI -1.0 to 1.25) after ES treatment compared to control. There was a significant treatment effect in favour of ES for improvement in pain-free range of passive humeral lateral rotation (Weighted Mean Difference (WMD) 9.17; 95% CI 1.43 to 16.91). In these studies ES reduced the severity of glenohumeral subluxation (SMD -1.13; 95% CI -1.66 to -0.60), but there was no significant effect on upper limb motor recovery (SMD 0.24; 95% CI -0.14 to 0.62) or upper limb spasticity (WMD 0.05; 95% CI -0.28 to 0.37). There did not appear to be any negative effects of electrical stimulation at the shoulder. REVIEWER'S CONCLUSIONS The evidence from randomised controlled trials so far does not confirm or refute that ES around the shoulder after stroke influences reports of pain, but there do appear to be benefits for passive humeral lateral rotation. A possible mechanism is through the reduction of glenohumeral subluxation. Further studies are required.
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Affiliation(s)
- C I Price
- Geriatric Medicine, University of Newcastle, c/o Helen Rodgers secretary, Centre for Health Services Research, 21 Claremont Place, Newcastle Upon Tyne, Tyne and Wear, UK, NE2 4AA.
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