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Shoulder Pain Interventions

Introduction

Shoulder pain resulting from post-stroke hemiplegia can lead to significant disability. Shoulder pain can be caused by spasticity and by the position of the hemiplegic joint. Hemiplegic shoulder pain can limit patient’s recovery and functional independence post-stroke. Most rehabilitation strategies aim to prevent and/or improve pain through different therapeutic mediums (e.g. functional electrical stimulation, mirror therapy, etc.), as well to optimize hemiplegic shoulder positioning (e.g. use of positioning techniques, slings, etc.). 

Authors: Tatiana Ogourtsova, MSc OT; Annabel McDermott, OT; Dr Nicol Korner-Bitensky, PhD OT.

 

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

 

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

 

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

 

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

 

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

Patients longer than 6 months post-stroke are identified as in chronic stage of recovery.

Patients longer than 6 months post-stroke are identified as in chronic stage of recovery.

Patients less than a month post-stroke are identified as in acute stage of recovery.

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

Patients longer than 6 months post-stroke are identified as in chronic stage of recovery.