This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Hanger, H C Articles by Sainsbury, R Search for Related Content PubMed PubMed Citation Articles by Hanger, H C Articles by Sainsbury, R Social Bookmarking                         What's this?

A randomized controlled trial of strapping to prevent post-stroke shoulder pain

P Whitewood

G Brown

M C Ball

J Harper

R Cox

R Sainsbury

The Princess Margaret Hospital, Christchurch, New Zealand

Objective: To determine whether strapping the shoulder in hemiplegic stroke patients: (1) prevents the development, or reduces the severity, of shoulder pain, (2) preserves range of movement in the shoulder, and (3) improves the functional outcomes for the arm and patient overall.

Design: A prospective, randomized, single-blind controlled trial of shoulder strapping versus no strapping.

Setting: Care of the elderly wards in a teaching hospital, Christchurch, New Zealand.

Subjects: All patients admitted with an acute hemiplegic stroke, who had persisting weakness of shoulder abduction.

Intervention: The treatment group had their affected shoulder strapped for six weeks from randomization in addition to standard physiotherapy.

Main outcome measures: All subjects were assessed at entry (week 0), at end of the treatment phase (week 6) and two months later (week 14). A visual analogue scale (VAS) was used to assess shoulder pain severity whereas shoulder range of movement to the point of pain (SROMP) assessed passive range of movement and pain. Functional Independence Measure (FIM), Motor Assessment Scale (MAS) and Rankin Disability Index measured functional outcomes.

Results: Ninety-eight subjects participated (49 strapped, 49 controls). Intention to treat analysis showed no significant difference in pain, range of movement or functional outcomes after the intervention phase or at the final assessment. However there were trends for less pain at six weeks (VAS, p = 0.11) and better final upper limb function (MAS, p = 0.16) in strapped patients. Skin reactions were uncommon (6.1%). The presence of neglect or sensory loss, but not subluxation, at baseline was independently associated with poor outcome. Range of movement was lost early (mean difference SROMP between hemiplegic and contralateral shoulders at baseline = 15.2° (95% CI 10.9–19.5)) and continued throughout the study. Shoulder strapping did not alter the rate at which range of movement was lost.

Conclusions: No significant benefit with shoulder strapping was demonstrated and reasons for this are discussed. Range of movement in the hemiplegic shoulder is lost very early and any preventive treatments need to begin within the first 1–2 days after a stroke.

Clinical Rehabilitation, Vol. 14, No. 4, 370-380 (2000)
DOI: 10.1191/0269215500cr339oa


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				A. Griffin and J. Bernhardt Strapping the hemiplegic shoulder prevents development of pain during rehabilitation: a randomized controlled trial Clinical Rehabilitation, April 1, 2006; 20(4): 287 - 295. [Abstract] [PDF]

				P. W. Duncan, R. Zorowitz, B. Bates, J. Y. Choi, J. J. Glasberg, G. D. Graham, R. C. Katz, K. Lamberty, and D. Reker Management of Adult Stroke Rehabilitation Care: A Clinical Practice Guideline Stroke, September 1, 2005; 36(9): e100 - e143. [Full Text] [PDF]

				R P. Van Peppen, G Kwakkel, S Wood-Dauphinee, H J. Hendriks, P. J Van der Wees, and J Dekker The impact of physical therapy on functional outcomes after stroke: what's the evidence? Clinical Rehabilitation, August 1, 2004; 18(8): 833 - 862. [Abstract] [PDF]

				S. Barreca, S. L. Wolf, S. Fasoli, and R. Bohannon Treatment Interventions for the Paretic Upper Limb of Stroke Survivors: A Critical Review Neurorehabil Neural Repair, December 1, 2003; 17(4): 220 - 226. [Abstract] [PDF]

				H C Hanger, B Fogarty, T J Wilkinson, and R Sainsbury Stroke patients' views on stroke outcomes: death versus disability Clinical Rehabilitation, April 1, 2000; 14(4): 417 - 424. [Abstract] [PDF]