QUESTIONS: Does circuit class therapy result in a greater incidence or severity of shoulder pain compared with individual therapy? Is the incidence influenced by the degree of active shoulder control? DESIGN: Controlled trial with intention-to-treat analysis. PARTICIPANTS: Sixty-eight people (6 drop-outs) undergoing inpatient rehabilitation after stroke. INTERVENTION: Participants received either individual therapy or group circuit class therapy. OUTCOME MEASURES: Incidence of shoulder pain over the previous 24 hours was measured as a yes/no response while severity of shoulder pain was measured using a visual analogue scale at admission, week 4, and discharge. RESULTS: There was no greater chance of participants receiving circuit class therapy having shoulder pain at week 4 (OR 0.95, 95% CI 0.32 to 2.80) or discharge (OR 0.38, 95% CI 0.11 to 1.45) than participants receiving individual therapy. Of those participants who reported pain, there was no difference between groups in the severity of pain at week 4 (mean difference -0.2 cm, 95% CI -3.2 to 2.7) or discharge (mean difference -2.1 cm, 95% CI -4.8 to 0.6). There was a greater chance of participants who had no active shoulder control having shoulder pain at week 4 (OR 5.8, 95% CI 1.6 to 20.4) and at discharge (OR 3.8, 95% CI 1.0 to 13.9) than participants who had active shoulder control. CONCLUSION: The incidence and severity of shoulder pain was influenced by degree of active shoulder control but not by type of physiotherapy service delivery. Concerns regarding shoulder pain should not be a barrier to the implementation of circuit class therapy during inpatient stroke rehabilitation.

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