Clinical Reasoning in the Use of Slings for Patients with Shoulder Subluxation after Stroke: A Glimpse of the Practice Phenomenon in California

Abstract

Literature reports the frequent use of shoulder slings by occupational therapists for the management of shoulder subluxation after stroke despite the low evidence for its efficacy. To understand the clinical contexts that defy current research evidence, a survey was distributed among California occupational therapists. One hundred sixty-eight participants responded to the survey, answering questions regarding the occurrences and clinical reasoning in the use of the shoulder sling with patients after stroke. Use of the shoulder sling was reported by 81.5% of the respondents. However, the actual sling prescription was limited to 28.4% of their patients. Slings were primarily prescribed for upper extremity management during functional mobility and for pain reduction. The orthopedic sling was the most frequently used sling. Reasons to use the orthopedic sling were largely based on pragmatic reasoning such as convenience and cost factors. On the contrary, therapists with advanced training were found to be more likely to apply procedural reasoning when choosing the proper sling for their patients.