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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:BackgroundShoulder pain is one of the most common musculoskeletal concerns in manual wheelchair users including among athletes. However, there is a paucity of research characterizing both shoulder pain and shoulder pathology in this population.ObjectiveTo characterize and compare the prevalence of current shoulder pain and ultrasound metrics of shoulder pathology between wheelchair athletes, nonathletic wheelchair users, and nonwheelchair users.DesignCross-sectional.SettingChicago-area adaptive sport teams/programs and musculoskeletal clinics.ParticipantsThirty-four wheelchair athletes, six nonathletic wheelchair users, and 12 nonwheelchair users.MethodsSelf-reported shoulder pain was assessed by questionnaire and Wheelchair User Shoulder Pain Index (WUSPI). Shoulder physiology and pathology were assessed by physical and ultrasound evaluation of both shoulders by a sports medicine physician.Main outcome measuresQuestionnaire outcomes: Prevalence of current shoulder pain, total WUSPI score. Physical examination outcomes: total Physical Examination of Shoulder Scale (PESS) score. Sonographic outcomes: Acromiohumeral distance (AHD) and presence of shoulder pathology.ResultsThe majority of wheelchair athletes (68%) and nonathletic wheelchair users (67%) experienced shoulder pain since using a manual wheelchair. Wheelchair basketball players had a mean WUPSI score of 17.2 (SD = 21.8), and athletes participating in handcycling, sled hockey, and quad rugby had mean scores of 4.91 (SD = 8.32), 7.76 (SD = 13.1), and 4.29 (SD = 7.75), respectively. Shoulder pathology was observed in 14 of 31 (45%) wheelchair athletes and 4 of 6 (67%) nonathletic wheelchair users (p = .41).ConclusionsAlthough wheelchair use is a risk factor for shoulder pain, participation in amateur wheelchair sports may not be associated with increased risk of shoulder pain. It is possible that overhead sports such as wheelchair basketball may define a unique high-risk group. Further study is needed to examine this relationship and to determine whether there are differences between specific wheelchair sports.

Project description:BackgroundNoninvasive physical management is often prescribed for headache and neck pain. Systematic reviews, however, indicate that the evidence of its efficacy is limited. Our aim was to evaluate the effectiveness of a workplace educational and physical program in reducing headache and neck/shoulder pain.Methodology/principal findingsCluster-randomized controlled trial. All municipal workers of the City of Turin, Italy, were invited to participate. Those who agreed were randomly assigned, according to their departments, to the intervention group (IG) or to the control group and were given diaries for the daily recording of pain episodes for 1 month (baseline). Subsequently, only the IG (119 departments, 923 workers) began the physical and educational program, whereas the control group (117 departments, 990 workers) did not receive any intervention. All participants were again given diaries for the daily recording of pain episodes after 6 months of intervention. The primary outcome was the change in the frequency of headache (expressed as the proportion of subjects with a ≥50% reduction of frequency; responder rate); among the secondary outcomes there were the absolute reduction of the number of days per month with headache and neck/shoulder pain. Differences between the two groups were evaluated using mixed-effect regression models. The IG showed a higher responder rate [risk ratio, 95% confidence interval (CI)] for headache (1.58; 1.28 to 1.92) and for neck/shoulder pain (1.53; 1.27 to 1.82), and a larger reduction of the days per month (95% CI) with headache (-1.72; -2.40 to -1.04) and with neck/shoulder pain (-2.51; -3.56 to -1.47).ConclusionsThe program effectively reduced headache and neck/shoulder pain in a large working community and appears to be easily transferable to primary-care settings. Further trials are needed to investigate the program effectiveness in a clinical setting, for highly selected patients suffering from specific headache types.Trial registrationClinicalTrials.gov NCT00551980.

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

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