Garner, J., Smith, M., and Gordon, S. (2016) A systematic review of the treatment for hemiplegic shoulder pain in the first six months following stroke. International Journal of Stroke, 11 (1). p. 11.

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Abstract

Objective: To investigate the effect of physiotherapy and occupational-therapy interventions in the treatment of patients with hemiplegic shoulder pain (HSP) within the first six months following a stroke.

Data Sources: CINHAL, PubMed and Medline were used as search databases.

Study Selection: Randomised, quasi-randomised and controlled trials wereincluded in the review. Pain measurement pre- and –post interventionincluded with participants within the first six months following stroke.Studies investigating reflex sympathetic dystrophy, or central causes to HSP were excluded along with pharmacological, surgical and invasive stimulation. Eighteen articles were reviewed, with consensus of two reviewers from the original 426 identified.

Data Extraction: Two reviewers independently use the CASP checklists to appraise methodological quality.

Data Synthesis: A qualitative review identified 11 different interventionshad been investigated. Studies using Electrical stimulation, interferentialcurrent, TENS, aromatherapy and acupressure, dry needling and active assisted hair brushing all found significant improvement on HSP. Stretching was found to have a non-significant increased risk of pain intwo out of three studies. Bobath therapy, forced use therapy and passiverange of movement using a constant passive movement machine failed toprovide a significant improvement in patients with HSP.

Conclusions: The results presented support the use of electrical-stimulation within clinical practice to treat HSP. TENS, interferential-current, hair brushing, dry needling, and aromatherapy combined withacupressure all had a significant effect on HSP, but were limited by under-powered studies. No study attempted to identify the cause for HSP prior to intervention beyond inclusion criteria of a stroke and experiencing shoulder pain.

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