Prevalence and Factors Related to Post Stroke Shoulder Pain in Hemiplegic Patients Receiving Home-based Rehabilitation in Post-acute Phase
Keywords:shoulder pain, shoulder subluxation, stroke, exercise, home-based rehabilitation
Objectives: To study the prevalence of shoulder pain and related factors in stroke patients with home-based rehabilitation in the post-acute phase.
Study design: Cohort study.
Setting: Phatthalung Hospital, Thailand.
Subjects: Stroke patients who had a home-based rehabilitation program and monthly follow-up for 6 months at Rehabilitation outpatient clinic from February 2019 to January 2020.
Methods: Demographic and medical data including types of stroke, motor power, sensation, the Brunnstorm’s arm recovery stage, shoulder subluxation, shoulder pain, self-care activities and home exercises, were recorded. Causes of shoulder pain was identified and treated until resolved. Factors such as using an overhead pulley for range of motion exercise and not using a shoulder sling while walking, were evaluated and analyzed.
Results: Of 110 patients, 58% reported shoulder pain, mean age was 64.14 (SD 13.91) years old, 80.9% had ischemic stroke, 58% had left side weakness, 52.7% had impaired sensation, 41.8% had the Brunnstorm’s arm recovery stage 1, and 50% had shoulder subluxation. Of those with shoulder pain, 64.1% developed shoulder pain within a month after onset. The most common diagnosis of shoulder pain was impingement syndrome (57.8%). Impaired sensation (adjusted OR=17.52; 95% CI 4.74-64.78), using an overhead pulley for range of motion exercise (adjusted OR = 33.92; 95% CI 3.35-343.39 ), and walking without a shoulder sling (adjusted OR = 11.68; 95% CI 1.28-106.88), were significantly associated with post stroke shoulder pain (p < 0.05).
Conclusion: Post stroke shoulder pain was common among patients with home-based rehabilitation during post-acute phase. Factors significantly associated with shoulder pain were having an impaired sensation, using an overhead pulley for shoulder range of motion exercise, and not using a shoulder sling while walking. Patient education including using a shoulder sling and not using an overhead pulley for shoulder exercise at home exercise should be emphasized to prevent shoulder pain.
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