PURPOSE: The purpose of this study was to develop evidence-based clinical practice guidelines for physiotherapy treatment of shoulder pain after stroke. The focus was on evidence for both prevention and intervention. METHOD: A search of published studies on stroke and shoulder pain was performed in the Cochrane Library, CINAHL and Medline databases. The search was limited to controlled or randomized clinical trials or meta-analyses in English. Fourteen references were found and reviewed. RESULTS: Hemiplegic shoulder pain, shoulder-hand syndrome and subluxation were the main conditions elucidated in the literature. The reported incidence of these conditions varied from 5% to 84%. Despite the variety of methods found in the studies, there is agreement that the aetiology is multifactorial and that repeated soft-tissue damage is to be avoided. Also, both prevention and intervention require coordinated multidisciplinary management. Prevention measures include the arm being supported at all times, and sufficient education of the patient, staff and relatives as to patient handling and individualized regimen. Support, education and individualized regimen are also recommended as intervention. The evidence for electrical stimulation is still limited. CONCLUSION: Limited evidence is present to address the problem of shoulder pain after stroke. However, this review suggests that prevention and intervention measures should avoid soft-tissue damage through coordinated multidisciplinary management.

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