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A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients.

ABSTRACT: To evaluate the effect of modified wheelchair arm-support to mitigate hemiplegic shoulder pain and reduce pain frequency in stroke patients.A single-blind randomized controlled trial using computer-generated simple randomization.Participants recruited from inpatients at the Guangdong Provincial Hospital of Chinese Medicine.A total of 120 patients with stroke were divided into two groups.All subjects underwent basic rehabilitation training and wheelchair assistance with eight weeks follow-up period. Patients in the treatment group additionally received modified wheelchair arm-support for at least 60?minutes a day, six days a week, for four weeks.Primary outcome was measured by the Visual Analogue Pain Scale or Numeric Pain Rating Scale. Secondary outcome was measured using the Upper Extremity Fugl-Meyer Assessment scale, Modified Barthel Index and Quality of Life Index. Measurements were made at 4?weeks and 12?weeks, following the intervention.Patients age from 21 to 83?years (mean?±?SD?=?62.41?±?12.26). The average duration of disease was 1.9?±?1.3?months. At four weeks, the median of pain intensity was higher in the control group (median, interquartile range?=?3, 5.75 vs. 2, 3.75; P?=?0.059). At 12?weeks, the median of pain intensity was higher in the control group (median, interquartile range?=?3, 5.00 vs. 0, 1.00; P?

SUBMITTER: Pan R

PROVIDER: S-EPMC5751850 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients.

Pan Ruihuan R Zhou Mingchao M Cai Hao H Guo Youhua Y Zhan Lechang L Li Mei M Yang Zhijing Z Zhu Leying L Zhan Jie J Chen Hongxia H

Clinical rehabilitation 20170619 1

<h4>Objective</h4>To evaluate the effect of modified wheelchair arm-support to mitigate hemiplegic shoulder pain and reduce pain frequency in stroke patients.<h4>Design</h4>A single-blind randomized controlled trial using computer-generated simple randomization.<h4>Setting</h4>Participants recruited from inpatients at the Guangdong Provincial Hospital of Chinese Medicine.<h4>Subjects</h4>A total of 120 patients with stroke were divided into two groups.<h4>Interventions</h4>All subjects underwent ...[more]

PMID: 28629270

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Project description:Hemiplegic shoulder pain is a frequent complication after stroke, leading to limited use of the affected arm. Neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation (TENS) are two widely used interventions to reduce pain, but the comparative efficacy of these two modalities remains uncertain. The purpose of this research was to compare the immediate and retained effects of EMG-triggered NMES and TENS, both in combination with bilateral arm training, on hemiplegic shoulder pain and arm function of stroke patients.A single-blind, randomized controlled trial was conducted at two medical centers. Thirty-eight patients (25 males and 13 females, 60.75 ± 10.84 years old, post stroke duration 32.68 ± 53.07 months) who had experienced a stroke more than 3 months ago at the time of recruitment and hemiplegic shoulder pain were randomized to EMG-triggered NMES or TENS. Both groups received electrical stimulation followed by bilateral arm training 3 times a week for 4 weeks. The primary outcome measures included a vertical Numerical Rating Scale supplemented with a Faces Rating Scale, and the short form of the Brief Pain Inventory. The secondary outcome measures were the upper-limb subscale of the Fugl-Meyer Assessment, and pain-free passive shoulder range of motion. All outcomes were measured pretreatment, post-treatment, and at 1-month after post-treatment. Two-way mixed repeated measures ANOVAs were used to examine treatment effects.Compared to TENS with bilateral arm training, the EMG-triggered NMES with bilateral arm training was associated with lower pain intensity during active and passive shoulder movement (P?=0.007, P?=0.008), lower worst pain intensity (P = 0.003), and greater pain-free passive shoulder abduction (P?=0.001) and internal rotation (P?=0.004) at follow-up. Both groups improved in pain at rest (P?=0.02), pain interference with daily activities, the Fugl-Meyer Assessment, and pain-free passive shoulder flexion and external rotation post-treatment (P?<?0.001) and maintained the improvement at follow-up (P?<?0.001), except for resting pain (P?=0.08).EMG-triggered NMES with bilateral arm training exhibited greater immediate and retained effects than TENS with bilateral arm training with respect to pain and shoulder impairment for chronic and subacute stroke patients with hemiplegic shoulder pain.NCT01913509 .

Project description:Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use. Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions treated by physical therapists. The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments. Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area. Our study investigates the effect of the latter approach.A randomized controlled trial of 10 weeks duration is currently being conducted. Employed office workers with severe neck-shoulder pain are randomized to 3 × 20 min shoulder function training with training supervision or to a reference group receiving advice to stay physically active. Shoulder function training primarily focuses on the serratus anterior and lower trapezius muscle with only minimal activation the upper trapezius.An announcement was sent to the administrative section of the university including jobs characterized by intensive computer work. The first 100 positive replies entered the study. Among these inclusion criteria were pain intensity in the neck/shoulder of at least 3 on a 0-9 scale. Exclusion criteria were cardiovascular disease, trauma, hypertension, or serious chronic disease. Before and after the intervention period the participants replied to a questionnaire about musculoskeletal disorders and work disability, and underwent a standardized clinical examination of the neck and shoulder girdle. Further, on a weekly basis the participants log pain intensity of the neck and shoulder during the previous week.The primary outcome measure is pain in the neck and shoulders at week 10 based on the weekly pain registration and results from the clinical examination. Secondary outcomes are strength and work disability.ClinicalTrials (NCT): NCT01205542.

Dataset Information

A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients.

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A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients.

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