A Systematic Review of Clinical Practice Guidelines for the Management of Shoulder Pain in Patients with Stroke


  • Weeranan Yaemrattanakul Prince of Songkla University
  • Tussaneeporn Soison Prince of Songkla University
  • Lalita Khuna Prince of Songkla University
  • Joanna Jackson University of Essex


assessment, guideline, hemiplegic shoulder pain, rehabilitation, stroke


Objectives: To assess the quality, scope, and consistency of relevant clinical practice guidelines (CPGs) recommendations for hemiplegic shoulder pain (HSP) management among stroke patients.

Study design: A systematic review of CPGs.

Setting: Publishing regions were North America, Europe, Asia, and Oceania.

Subjects: Adult (≥ 18 years) stroke patients who had HSP.

Methods: Seven databases were used to search for CPGs. A total of 267 articles were screened; 8 guidelines met the inclusion criteria. The Appraisal of Guideline for Research and Evaluation (AGREE-II) was used for evaluating the quality of the selected CPGs.

Results: The recommendations of 5 high-quality guidelines for post-stroke HSP management were synthesized and 5 scopes of consistent recommendations were found comprising assessment, prevention, medical treatment, physical therapy treatment, and management of shoulder subluxation.

Conclusions: The key recommendations proposed that the assessment should evaluate muscle tone and pain level; advice and education be provided to family members and caregivers on how to handle and position the shoulder correctly, and avoid exercises involving overhead pulleys to prevent HSP; medical treatment should consider the administration of analgesics, high doses of botulinum toxin injections, subacromial corticosteroid injections, and suprascapular nerve blocks; and that physical therapy approaches should employ active exercises, taping or strapping, and the management of shoulder subluxation via slings and electrical stimulation. Future up-to-date guidelines should consider all domains of AGREE-II in order to improve their quality.

Keywords: assessment, guideline, hemiplegic shoulder pain, rehabilitation, stroke



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