Original articlePoststroke Shoulder Pain: Its Relationship to Motor Impairment, Activity Limitation, and Quality of Life
Section snippets
Participants
We analyzed the baseline data of stroke survivors enrolled in a multicenter randomized clinical trial of percutaneous electric stimulation for the treatment of poststroke shoulder pain.14, 15 The clinical trials protocol was approved by the institutional review boards at each participating center. Participants were more than 12 weeks poststroke (hemorrhagic or nonhemorrhagic) and were at least 18 years old. Participants had (1) shoulder pain graded as at least 2 on the 11-point numeric rating
Results
Data were available for all 61 stroke survivors enrolled in the clinical trial. The mean age ± standard deviation (SD) of participants was 58.6±12.1 years, 44% were women, 84% sustained nonhemorrhagic strokes, and 62% had left hemiplegia. Other characteristics of the participants are shown in table 2.
Table 3 shows the results of the stepwise regression analyses. BPI 12 was not associated with the FMA, but pain-free external rotation ROM and the degree of inferior subluxation were directly and
Discussion
Poststroke shoulder pain was associated with reduced QOL related to pain. Our study, however, failed to demonstrate a statistical relationship between poststroke shoulder pain and motor impairment and activity limitation.
In an earlier World Health Organization definition,29 health and QOL reflected the constructs of physical, mental, and social well-being and not merely the absence of disease. Today, however, QOL is generally referred to as a multidimensional construct involving the physical,
Conclusions
Poststroke shoulder pain is associated with pain-related QOL. This provides a further incentive to develop effective rehabilitation prevention and treatment strategies for poststroke shoulder pain. Our data did not identify a relationship between poststroke shoulder pain, motor impairment, and activity limitation. This, however, may have been an artifact of a study design that did not include stroke survivors free of poststroke shoulder pain, rather than a true lack of a relationship.
References (32)
- et al.
Post stroke shoulder pain: more common than previously realized
Eur J Pain
(2000) - et al.
Arthrographic and clinical findings in patients with hemiplegic shoulder pain
Arch Phys Med Rehabil
(2003) - et al.
Intramuscular neuromuscular electric stimulation for poststroke shoulder pain: a multicenter randomized clinical trial
Arch Phys Med Rehabil
(2004) - et al.
Validation of the Brief Pain Inventory for chronic nonmalignant pain
J Pain
(2004) - et al.
Percutaneous intramuscular neuromuscular electric stimulation for the treatment of shoulder subluxation and pain in patients with chronic hemiplegia: a pilot study
Arch Phys Med Rehabil
(2001) - et al.
Inter- and intrarater reliability of the Ashworth Scale and the Disability Assessment Scale in patients with upper-limb poststroke spasticity
Arch Phys Med Rehabil
(2002) - et al.
The Functional Independence Measure: tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories
Arch Phys Med Rehabil
(1996) - et al.
The Arm Motor Ability Test: reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living
Arch Phys Med Rehabil
(1997) - et al.
Dynamic cancer pain management outcomes: the relationship between pain severity, pain relief, functional interference, satisfaction and global quality of life over time
J Pain Symptom Manage
(2002) - et al.
Hemiplegic shoulder pain: defining the problem and its management
Disabil Rehabil
(2001)
Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway
Clin Rehabil
Shoulder pain in hemiplegia: statistical relationship with five variables
Arch Phys Med Rehabil
Evaluation and treatment of shoulder subluxation in hemiplegia: relationship between subluxation and pain
Am J Phys Med Rehabil
The source of shoulder pain in hemiplegia
Arch Phys Med Rehabil
Painful shoulder in hemiplegia
Arch Phys Med Rehabil
Reflex sympathetic dystrophy in hemiplegia
Arch Phys Med Rehabil
Cited by (112)
Sonographic Predictors in Patients with Hemiplegic Shoulder Pain: A Cross-Sectional Study
2020, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :These findings emphasize that when effusion is detected sonographically in SA-SD bursa, the rotator cuff should be evaluated carefully for a tear to improve diagnostic ability. Although there are studies reporting the relationship between shoulder pain and quality of life in hemiplegic patients in the literature6,9,30, in this study we preferred to investigate the relationship between abnormal sonographic findings and quality of life. In a small cross-sectional study, Chae et al. concluded that there was a statistically significant relationship between shoulder pain and quality of life.9
Implementing a Pain Assessment Survey and Team Approach Method to Effectively Assess and Treat Pain in Poststroke Patients
2020, Archives of Rehabilitation Research and Clinical TranslationRisk Factors for Poststroke Shoulder Pain: A Systematic Review and Meta-Analysis
2020, Journal of Stroke and Cerebrovascular DiseasesShoulder pain after recent stroke (SPARS): hemiplegic shoulder pain incidence within 72 hours post-stroke and 8–10 week follow-up (NCT 02574000)
2020, Physiotherapy (United Kingdom)Citation Excerpt :Paci’s group [24] reported that recent, larger studies with more than 70 participants showed a significant association between muscle weakness, subluxation and shoulder pain [3–5,8,13,14,19], suggesting smaller studies were underpowered. Subluxation and motor weakness are key risk factors for shoulder pain because initial muscle weakness and development of subluxation alter joint biomechanics resulting in repeated microtrauma to the capsular and extra-capsular structures causing pain early after stroke [10]. Biceps and supraspinatus muscles are key shoulder stabilizers and vulnerable to traction damage from the weight of the weak arm [21].
Hemiplegic shoulder pain affects ipsilesional aiming movements after stroke: a cross-sectional study
2024, Physiotherapy Theory and Practice
Supported in part by the National Institute for Child Health and Human Development (grant nos. R44HD34996, K12HD01097), the National Center for Research Resource (grant no. M01RR0080), and by the NeuroControl Corp, North Ridgeville, OH.
A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit upon the author or 1 or more of the authors. NeuroControl Corp has a direct interest in the content of this article with respect to a device NeuroControl intends to commercialize. Chae is a consultant to NeuroControl. Fang is an employee of NeuroControl. At the time of the study, Yu was a consultant to NeuroControl, but is no longer affiliated with NeuroControl.
- 1
Yu is now affiliated with Virginia Mason Medical Center, Seattle, WA, and Bioness Inc, Santa Clarita, CA
- 2
Kirsteins is now affiliated with Moses Cones Health System, Greensboro, NC
- 3
Zorowitz is now affiliated with Johns Hopkins Bayview Medical Center, Baltimore, MD.