Original article
Poststroke Shoulder Pain: Its Relationship to Motor Impairment, Activity Limitation, and Quality of Life

Presented in part to the Association of Academic Physiatrists, March 2006, Daytona, FL.
https://doi.org/10.1016/j.apmr.2006.12.007Get rights and content

Abstract

Chae J, Mascarenhas D, Yu DT, Kirsteins A, Elovic EP, Flanagan SR, Harvey RL, Zorowitz RD, Fang Z-P. Poststroke shoulder pain: its relationship to motor impairment, activity limitation, and quality of life.

Objective

To assess the relationship between poststroke shoulder pain, upper-limb motor impairment, activity limitation, and pain-related quality of life (QOL).

Design

Cross-sectional, secondary analysis of baseline data from a multisite clinical trial.

Setting

Outpatient rehabilitation clinics of 7 academic medical centers.

Participants

Volunteer sample of 61 chronic stroke survivors with poststroke shoulder pain and glenohumeral subluxation.

Interventions

Not applicable.

Main Outcome Measures

We measured poststroke shoulder pain with the Brief Pain Inventory question 12 (BPI 12), a self-reported 11-point numeric rating scale (NRS) that assesses “worst pain” in the last 7 days. Motor impairment was measured with the Fugl-Meyer Assessment (FMA). Activity limitation was measured with the Arm Motor Ability Test (AMAT) and the FIM instrument. Pain-related QOL was measured with BPI question 23, a self-reported 11-point NRS that assesses pain interference with general activity, mood, walking ability, normal work, interpersonal relationships, sleep, and enjoyment of life.

Results

Stepwise regression analyses indicated that poststroke shoulder pain is associated with the BPI 23, but not with the FMA, FIM, or AMAT scores.

Conclusions

Poststroke shoulder pain is associated with reduced QOL, but not with motor impairment or activity limitation.

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.

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    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.

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