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Abstract

Objective

To evaluate if positioning the upper-limb promoting abduction, external rotation and flexion of the shoulder reduces the intensity of post-stroke shoulder pain at day-7 compared to usual clinical practice.

Design & setting

Prospective single-center randomized clinical trial using a superiority design comparing two preventive strategies of post-stroke shoulder pain in a stroke unit.

Subjects

Patients were included within 2 days from a first symptomatic ischemic stroke affecting shoulder motor function.

Interventions

Intervention group included specific positioning of the shoulder in abduction, external rotation and flexion in bed, chair and during mobilization. Control group referred to usual practice i.e. positioning using a standard support scarf.

Main measures

Primary outcome was the intensity of shoulder pain assessed by the visual analog scale (VAS) (0–100) at day-7 post-stroke. Other outcomes measured at day-7 and 2 months post-stroke were the VAS, motor function, spasticity, depression, functional independence and rates of complex regional Pain syndrome (CRPS).

Results

76 patients (49 males; mean age = 68.3) were randomized. The shoulder pain at day-7 was not different between the control group (16.1, SD = 27.4) and the intervention group (10.3, SD = 21.5, p = 0.18) as well as at 2 months (p = 0.12). A lower rate of depression was observed in the intervention group at 2 months 36.7% (CI95% 19.9;56.1) vs 52.9% (CI95% 35.1;70.2). No between-group difference in other outcomes was observed at 2 months.

Conclusions

This study failed to demonstrate the benefit of a specific positioning tool in reducing the intensity of post-stroke shoulder pain which was lower than previously reported in the literature.

Keywords

Shoulder pain stroke rehabilitation

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References

McLean

. Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation. Arch Phys Med Rehabil 2004; 85: 466–469.

Lindgren

Gard

Brogårdh

. Shoulder pain after stroke–experiences, consequences in daily life and effects of interventions: a qualitative study. Disabil Rehabil 2018; 40: 1176–1182.

Kumar

. Hemiplegic shoulder pain in people with stroke: present and the future.

McKenna

. Hemiplegic shoulder pain: defining the problem and its management. Disabil Rehabil 2001; 23: 698–705.

Nadler

Pauls

Cluckie

, et al. Shoulder pain after recent stroke (SPARS): hemiplegic shoulder pain incidence within 72 h post-stroke and 8–10 week follow-up (NCT 02574000). Physiotherapy 2020; 107: 142–149.

Wilson

Chae

. Hemiplegic shoulder pain. Phys Med Rehabil Clin N Am 2015; 26: 641–655.

Ada

Foongchomcheay

Canning

. Supportive devices for preventing and treating subluxation of the shoulder after stroke. Cochrane Database Syst Rev 2005; 2005: CD003863.

Teasdale

Jennett

. Assessment of coma and impaired consciousness: a practical scale. The Lancet 1974; 304: 81–84.

Stevens

Marshall

Cornblath

, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med 2009; 37: S299–S308.

10.

Charalambous

. Interrater reliability of a modified Ashworth scale of muscle spasticity. In: Banaszkiewicz P and Kader D (eds) Classic papers in orthopaedics. London: Springer, 2014, pp.415–417.

11.

Goodglass

Kaplan

. Boston Diagnostic Aphasia Examination (BDAE).

12.

Mazaux

Orgogozo

. Echelle d’évaluation de l’aphasie adaptée du Boston Diagnostic Aphasia Examination. Paris: EAP Editions Psychotechniques, 1982.

13.

DeLoach

Higgins

Caplan

, et al. The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg 1998; 86: 102–106.

14.

Brott

Adams

Olinger

, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989; 20: 864–870.

15.

Montgomery

Åsberg

. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382–389.

16.

Mahoney

Barthel

. Functional evaluation: the Barthel Index: a simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Md State Med J 1965; 14: 61–65.

17.

Harden

Bruehl

Perez

, et al. Validation of proposed diagnostic criteria (the “Budapest Criteria”) for complex regional pain syndrome. Pain 2010; 150: 268–274.

18.

Stinear

. Prediction of motor recovery after stroke: advances in biomarkers. The Lancet Neurology 2017; 16: 826–836.

19.

Candelise

Gattinoni

Bersano

, et al. Stroke-unit care for acute stroke patients: an observational follow-up study. The Lancet 2007; 369: 299–305.

20.

Bernhardt

Godecke

Johnson

, et al. Early rehabilitation after stroke. Curr Opin Neurol 2017; 30: 48–54.

21.

Menoux

Jousse

Quintaine

, et al. Decrease in post-stroke spasticity and shoulder pain prevalence over the last 15 years. Ann Phys Rehabil Med 2019; 62: 403–408.

22.

Huang

Y-C

Leong

Wang

, et al. Effect of kinesiology taping on hemiplegic shoulder pain and functional outcomes in subacute stroke patients: a randomized controlled study. Eur J Phys Rehabil Med 2016; 52: 774–781.

23.

Huang

Y-C

Leong

C-P

Tso

H-H

, et al. The long-term effects of hyaluronic acid on hemiplegic shoulder pain and injury in stroke patients: a randomized controlled study. Medicine (Baltimore) 97: e12078.

24.

Ratanapinunchai

Mathiyakom

Sungkarat

. Scapular upward rotation during passive humeral abduction in individuals with hemiplegia post-stroke. Ann Rehabil Med 2019; 43: 178.

25.

Pain

Baker

Sohail

, et al. 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 2020; 42: 3072–3083.

26.

Veneman

Jung

Manterola del Puerto

, et al. Clinical validation of a novel postural support device for hospitalized sub-acute post-stroke wheelchair users. Disabil Rehabil: Assist Technol 2017; 12: 526–534.

27.

Pan

Zhou

Cai

, et al. A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients. Clin Rehabil 2018; 32: 37–47.

28.

Serrezuela

Quezada

Zayas

, et al. Robotic therapy for the hemiplegic shoulder pain: a pilot study. J Neuroeng Rehabil 2020; 17: 1–12.

29.

Torres-Parada

Vivas

Balboa-Barreiro

, et al. Post-stroke shoulder pain subtypes classifying criteria: towards a more specific assessment and improved physical therapeutic care. Braz J Phys Ther 2020; 24: 124–134.

30.

Zeilig

Rivel

Weingarden

, et al. Hemiplegic shoulder pain: evidence of a neuropathic origin. Pain 2013; 154: 263–271.

31.

Duray

Baskan

. The effects of hemiplegic shoulder pain on upper extremity motor function and proprioception. NeuroRehabilitation 2020; 46: 561–567.

32.

Hama

Yamashita

Yamawaki

, et al. Post-stroke depression and apathy: interactions between functional recovery, lesion location, and emotional response. Psychogeriatrics 2011; 11: 68–76.

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Early multidisciplinary prevention program of post-stroke shoulder pain: A randomized clinical trial