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Impact of Therapeutic Exercises on Shoulder Pain in Stroke Patients with Hemiplegic Arm

This study evaluates whether therapeutic exercises, specifically Passive Range of Motion (PROM), Skateboard (SB), and Overhead Pulley (OP) techniques, contribute to shoulder pain in stroke patients with hemiplegic arms. Conducted with a sample of 48 patients, the outcomes indicate a significant risk of shoulder pain development, particularly in the OP group, with a 71% incidence. Results show no significant differences among groups, suggesting careful consideration of exercise methods in rehabilitation to mitigate pain while restoring limb function.

uriah-farmer
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Impact of Therapeutic Exercises on Shoulder Pain in Stroke Patients with Hemiplegic Arm

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  1. Clinical Question: Do therapeutic exercise for hemiplegic arm cause the shoulder pain in patients with stroke? • Searching databank: MEDLINE, PubMed,CINAL • Searching strategy: [ rehabilitation & ( adverse effect or harm or complication or side effect ) & stroke ] ; [ physical therapy technique & ( adverse effect or harm or complication or side effect ) & stroke ] ; [ exercise therapy & ( adverse effect or harm or complication or side effect ) & stroke ] • Limitation: English and human and clinical trial

  2. Citation • Kumar R, Metter EJ, Mehta AJ, Chew T: Shoulder pain in hemiplegia - the role of exercise. Am J Phys Med Rehabil 1990;69:205-8.

  3. Introduction (1) • Exercise is the most important therapy in restoration of physical independence in patients with stroke. • PROM is done when there is no voluntary movement in the extremities to avoid joint contracture; AROM and AAROM are added to the program when the patients starts to regain voluntary control.

  4. Introduction (2) • three type of exercises commonly used during rehabilitation of the UE in patients with stroke • Passive range of motion (PROMT) • Skate board (SB) • Overhead pulley (OP) • Purpose of the study • To evaluate whether any of these exercises could initiate shoulder pain in patients with stroke

  5. Methods (1) First stroke n=48 could’n’t complete the program n=2 Receive therapy before admission n=10 Severe aphasia and cognition Dysfunction n=6 Already developed pain n=8 PROMT n=12 SB n=8 OP n=8

  6. Methods (2) • Initial evaluation: subluxation of the shoulder , PROM for the upper limb, muscle strength (MMT) • Outcome measures: pain at rest or during PROM • Record “ yes “ or “ no “ • Every month for 3 months • Blinded evaluator A.J.M • Intervention: performed by OT only • 1 / day * 5 days/wk * ? Wks • Presence of shoulder pain

  7. Scapular plane

  8. Results (1) * p<.05 * p<.05  25% (7/28) developed shoulder ; 71% patients in OP group

  9. Results (2)

  10. Results (3)  No sig difference btw groups, p=0.62

  11. Results (4)  No sig difference btw groups, p=0.25

  12. Relative risk (1) • Relative Risk = RR = [a/(a+b)]/[c/(c+d)] =(5/8) / (1/12) =7.5 • Severe adverse event ( if OR>3)

  13. Relative odds (2) •  Relative Risk = RR = [a/(a+b)]/[c/(c+d)] =(5/8) / (1/8) =5 • Severe adverse event ( if OR>3)

  14. Relative odds (3) •  Relative Risk = RR = [a/(a+b)]/[c/(c+d)] =(1/8) / (1/12) =1.5 • Minor adverse event

  15. Relative odds (4) •  Relative Risk = RR = [a/(a+b)]/[c/(c+d)] =(5/8) / (2/20) =6.25 • Severe adverse event ( if OR>3)

  16. Critical Appraisal Worksheet

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