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 AND 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 ie positioning using a standard support scarf. MAIN MEASURES: Primary outcome was the intensity of shoulder pain assessed by the visual analog scale (VAS) (0 to 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% (95% CI 19.9 to 56.1) versus 52.9% (95% CI 35.1 to 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.

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