Poststroke shoulder pain and its association with upper extremity sensorimotor function, daily hand activities, perceived participation, and life satisfaction

An investigation of upper extremity function, sleep quality, and functional independence in patients with poststroke shoulder pain: a cross-sectional study

BACKGROUND

Poststroke shoulder pain (PSSP) is a common poststroke complication. Even though it is a common phenomenon, it is unclear how it impacts the patient's life.

OBJECTIVE

To investigate the differences in upper extremity function, sleep quality, and functional independence between patients with and without PSSP.

METHODS

This cross-sectional study included 63 participants with stroke (32 patients with PSSP and 31 patients without PSSP). Shoulder pain was evaluated with a Visual Analog Scale and the participants were divided into two groups as those with and without PSSP. The upper extremity function was assessed with the Disabilities of the Arm, Shoulder, and Hand Questionnaire, the Arm Motor Ability Test, and the Nine Hole Peg Test. Sleep quality was assessed with Pittsburgh Sleep Quality Index and the functional independence was assessed with the Functional Independence Measure. All data were analyzed using the program IBM SPSS Statistics 22.0. The Mann-Whitney U test was used to compare the non-normally distributed parameters, and the Chi-square test was used to compare the ordinal variables. The Spearman correlation test was used for the relationship and a linear regression test was used for regression.

RESULTS

Upper extremity function decreased (p < .05), only the sleep disturbance sub-parameter of sleep quality increased (p = .01), and functional independence increased in patients with PSSP (p < .001). There was a moderate relationship between pain and upper extremity function and a fair relationship between pain and sleep quality (use of sleep medications, daytime dysfunction sub-parameters) (p < .05).

CONCLUSIONS

PSSP impairs upper extremity functions, which play an important role in activities of daily living, and reduces functional independence. These results suggest that it is important to evaluate shoulder pain and examine the factors affecting pain in the rehabilitation of patients with stroke.

Assessing the Social and Environmental Impact of Healthcare Technologies: Towards an Extended Social Return on Investment

Stroke is the third leading cause of death and disability overall worldwide. Upper limb impairment is a common consequence for stroke survivors, having negative impact on their quality of life. Robotic rehabilitation, through repetitive and monitored movements, can improve their status. Developed by a team of researchers at Politecnico di Milano, AGREE is an exoskeleton for upper limb rehabilitation at the stage gate between translational research and clinical validation. Since the cost of this device is particularly high, the present study aimed to provide a framework for assessing its value. The Social Return on Investment (SROI) method, able to grasp the economic, social and environmental impact of an activity, was applied, using expert opinions of a pool of clinical engineers and healthcare professionals from different Italian hospitals to obtain information. Environmental impacts were estimated through Life Cycle Assessment in terms of CO₂ emissions and incorporated in the analysis. Considering a 5-year period, the SROI for a single exoskeleton was 3.75:1, and the SROI for the number of exoskeletons projected to be sold was 2.868:1, thus resulting largely in value for money. This study provides a model for combining economic, social and environmental outcomes that, besides contributing to theory, could be useful for decision-making.

Life satisfaction after stroke and the association with upper extremity disability, sociodemographics, and participation

INTRODUCTION

Remaining disability after stroke can reduce a person's life satisfaction. Because previous studies of life satisfaction show inconsistent results, there is a need for more knowledge regarding perceived life satisfaction after stroke and associated factors.

OBJECTIVE

To assess perceived life satisfaction after stroke in relation to Swedish reference values; and the association with upper extremity disability, sociodemographics, and participation.

DESIGN

Cross-sectional study.

SETTING

University hospital.

PARTICIPANTS

Seventy-five persons (72% male) with mild to moderate disability in a stable phase after stroke.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11), which includes one global item Life as a whole and 10 domain-specific items. Global life satisfaction and explanatory factors were evaluated in two multivariate logistic regression models.

RESULTS

Fifty-three percent of the participants were satisfied with Life as a whole. Highest satisfaction was found for Family life (78%) and Partner relationship (77%) and lowest satisfaction for Vocational situation (32%), Sexual life (25%), and Physical health (23%). Life as a whole and most domain-specific items showed a significantly lower proportion of satisfied persons compared to Swedish reference values. In the first regression model with factors of upper extremity disability, manual ability was the strongest explanatory variable for Life as a whole (p value = .032, Nagelkerke R Square 0.117). In the second regression model, participation, social, and working status were the final explanatory variables (p value = .006, Nagelkerke R Square = 0.207).

CONCLUSION

Our findings indicate that persons with mild to moderate disability after stroke perceive overall less satisfaction with Life as a whole and domain-specific items than the general Swedish population. To increase a person's life satisfaction after stroke, rehabilitation interventions should target a variety of aspects including enhancing functioning of upper extremity, reducing participation restrictions, and providing support regarding social and vocational situation.

Self-Perceived Life Satisfaction during the First Wave of the COVID-19 Pandemic in Sweden: A Cross-Sectional Study

Currently, there is limited knowledge on how the Swedish strategy with more lenient public health restrictions during the COVID-19 pandemic has influenced people's life satisfaction. Here, we investigated self-reported life satisfaction during the first wave of the pandemic in Sweden, and perceived changes in life satisfaction in relation to various sociodemographic factors. A total of 1082 people (mean age 48 (SD 12.2); 82% women) responded to an online survey during autumn 2020 including the "Life Satisfaction Questionnaire-11". A majority (69%) were satisfied with life as a whole, and with other important life domains, with the exception of contact with friends and sexual life. An equal share reported that life as a whole had either deteriorated (28%) or improved (29%). Of those that perceived a deterioration, 95% considered it to be due to the pandemic. Regarding deteriorated satisfaction with life as a whole, higher odds were found in the following groups: having no children living at home; being middle aged; having other sources of income than being employed; and having a chronic disease. The Swedish strategy might have contributed to the high proportion of satisfied people. Those who perceived a deterioration in life satisfaction may, however, need attention from Swedish Welfare Authorities.

The effects of hemiplegic shoulder pain on upper extremity motor function and proprioception

BACKGROUND

Hemiplegic shoulder pain (HSP) after stroke has negative effects on functional use of hemiplegic arm.

OBJECTIVE

This study aimed to investigate the effects of HSP on upper extremity motor function and proprioception.

METHODS

Hundred and twenty-two patients with hemiplegia were included in this study. The patients' shoulder pain was evaluated by Visual Analog Scale. According to pain scores, patients were divided into two groups as group with HSP (Group 1, n = 76) and group without HSP (Group 2, n = 46). Upper extremity motor function level and proprioception were assessed by using Fugl Meyer Motor Function Scale and the Laser-pointer Assisted Angle Reproduction Test for the 45°, 60° and 90° of shoulder flexion.

RESULTS

Upper extremity motor function and shoulder's proprioceptive sense at each angles of group 1 were found significantly worse than group 2's (p≤0.005). Correlation analysis revealed a significant positive correlation between HSP severity, and upper extremity motor dysfunction and proprioceptive impairment (p < 0.005).

CONCLUSIONS

Presence of HSP is one of the main determinators of upper extremity motor function level and proprioceptive ability at different angles. Management of HSP can make a significant contribution to sensorimotor integration by leading to recovery in the motor function and proprioceptive acuity.

Life Satisfaction in Persons With Late Effects of Polio: A Test-Retest Reliability Study

BACKGROUND

The Life Satisfaction Questionnaire (LiSat-11), including one global item and 10 domain-specific items, is used to evaluate life satisfaction in persons with the late effects of polio (LEoPs). However, there is a lack of knowledge about its psychometric properties.

OBJECTIVE

To evaluate the test-retest reliability of the LiSat-11 and the associations between the global and domain-specific items in persons with LEoPs.

DESIGN

A test-retest design, where data were collected by a postal survey.

SETTING

University Hospital, Outpatient Clinic.

PARTICIPANTS

A cross-sectional sample of persons (20 women and 31 men; mean age 72 years) with LEoPs.

MAIN OUTCOME MEASUREMENTS

LiSat-11, assessing how satisfied a person is with different aspects of life, such as life as a whole, vocation, economy, leisure, contacts with friends and acquaintances, sexual life, activities of daily living (ADLs), family life, partner relationship, somatic health, and psychological health.

METHODS

LiSat-11 was administered on two occasions, 2 weeks apart. The test-retest reliability was evaluated by Kappa statistics, the percent agreement (PA), and the Svensson rank-invariant method. The association between the items was evaluated with the Spearman rank correlation coefficient (rho).

RESULTS

The Kappa coefficients showed good to excellent agreement (0.64-0.90) and the PA ≤1 point was high (>92%) for all items. No items showed any systematic or random disagreements according to the Svensson method. All domain-specific items correlated significantly with the global item "Life as a whole" (P < .01; rhos 0.41 to 0.75).

CONCLUSIONS

LiSat-11 is reliable for assessing life satisfaction in persons with LEoPs. The global item "Life as a whole" is useful as an overall measure but cannot fully replace the information obtained from the domain-specific items of LiSat-11.

Estimation of Motor Impairment and Usage of Upper Extremities during Daily Living Activities in Poststroke Hemiparesis Patients by Observation of Time Required to Accomplish Hand Dexterity Tasks

Aim. This study evaluated whether specific actual performance could accurately predict body function levels and upper limb use in the real-life functioning of poststroke hemiparesis patients to aid in choosing the most appropriate rehabilitation exercises. Methods. We measured the time taken for poststroke patients to move small objects with the paralyzed hand and investigated how the measurement could estimate upper extremity motor impairment and hand usage during activities of daily living (ADL). We examined 86 stroke patients (age 66 ± 16 years) whose upper extremity motor paralysis was measured using the Fugl-Meyer assessment (FMA) and Southampton Hand Assessment Procedure (SHAP), and patient-reported ADL was investigated using the Jikei Assessment Scale for Motor Impairment in Daily Living (JASMID). To identify the time required to perform each SHAP item, we employed a linear regression analysis. The prediction formula was used in the linear regression analysis, and the coefficient of determination (R2) was applied to compare each component item score that was obtained with the predicted values derived from the linear regression analysis. Results. The most easily accomplished task was Heavy Power in the SHAP. The R2 between the SHAP Heavy Power item score and the FMA scores was moderate (R2 = 0.344, P<0.0001), whereas the R2 with the JASMID score was low (R2 = 0.126, P<0.001). Conclusions. By measuring the time it takes for poststroke hemiparesis patients to hold and move an object, we developed a prediction formula for upper extremity motor function and hand dexterity.

Association between Physiological and Subjective Aspects of Pain and Disability in Post-Stroke Patients with Shoulder Pain: A Cross-Sectional Study

Background: Patients often experience pain as a result of a stroke. However, the mechanism of this pain remains uncertain. Our aim was to investigate the relationship between pressure pain thresholds (PPTs) and disability pain in patients with hemiplegic shoulder pain (HSP). Methods: Twenty-six post-stroke patients (age 53.35 ± 13.09 years) and healthy controls (54.35 ± 12.37 years) participated. We investigated spontaneous shoulder pain, disability pain perception through the shoulder pain and disability index (SPADI), and the PPTs over joint C5–C6, upper trapezius, deltoid, epicondyle, second metacarpal, and tibialis anterior, bilaterally. Results: The analysis of variance (ANOVA) showed significant differences in pain between groups (p < 0.001) and differences in the SPADI (p < 0.001) between groups but not between sides for PPTs over deltoid (group: p = 0.007; side: p = 0.750), epicondyle (group: p = 0.001; side: p = 0.848), and tibialis anterior (group: p < 0.001; side: p = 0.932). Pain in the affected arm was negatively associated with PPTs over the affected epicondyle (p = 0.003) and affected tibialis anterior (p = 0.009). Pain (SPADI) appeared negatively correlated with PPTs over the affected epicondyle (p = 0.047), and disability (SPADI) was negatively associated with PPTs over the affected tibialis anterior (p = 0.041). Conclusions: Post-stroke patients showed a relationship between widespread pressure pain hypersensitivity with lower PPT levels and pain disability perception, suggesting a central sensitization mediated by bilateral and symmetric pain patterns.

Post-stroke shoulder pain subtypes classifying criteria: towards a more specific assessment and improved physical therapeutic care

BACKGROUND

Post-stroke Shoulder Pain (PSSP) is a common stroke-related syndrome that prolongs hospitalization and diminishes quality of life. PSSP studies were unsuccessful in clarifying pathophysiological mechanisms. Therefore, cohort's studies with greater variety of the sample and larger follow-up period could provide additional clinical data and may improve medical care.

OBJECTIVE

To classify people with PSSP and identify intergroup clinical differences, providing additional data useful for therapeutic care planning.

METHODS

One thousand individuals with stroke were selected from all levels of one health Area and followed up during one year. Demographic data, stroke clinical characteristics, stroke-related symptoms and rehabilitation parameters were collected. The shoulder muscle impairment was used to group participants into three clinical profiles: severe muscular impairment, moderate muscular impairment and low muscular impairment groups.

RESULTS

A total of 119 individuals were diagnosed with PSSP. The suggested classification criteria showed two groups that differed significantly in relation to the onset and duration of PSSP, presence of sensory and speech impairment, and spasticity. The outcomes did not firmly support the existence of a third suggested PSSP subtype.

CONCLUSIONS

PSSP may vary in onset, clinical manifestations, severity and syndrome duration. These results highlight the course of different clinical profiles and require multidisciplinary management approaches.

Sensory Function, Measured as Active Discriminative Touch, is Associated With Dexterity after Stroke

BACKGROUND

Reduced dexterity is common after stroke, which can affect the ability to perform upper limb daily activities. To improve upper limb function after stroke, it is important to understand which factors are most associated with dexterity.

OBJECTIVE

To evaluate how several factors are associated with dexterity after stroke.

DESIGN

Cross-sectional study.

SETTING

A university hospital.

PARTICIPANTS

A convenience sample of 75 persons (54 men and 21 women, mean age 66 years) with mild to moderate impairments of the upper limb after stroke.

METHODS

Dexterity and potentially associated factors (age, gender, affected hand, social situation, vocational situation, grip strength, spasticity, sensory function, and pain) were evaluated by linear regression models.

MAIN OUTCOME MEASUREMENTS

Dexterity was measured with the mini Sollerman Hand Function Test, sensory function with both the Fugl-Meyer Assessment of the Upper Extremity (to assess light touch and proprioception) and the Shape Texture Identification Test (to assess active discriminative touch), spasticity with the Modified Ashworth Scale, and grip strength with the Grippit dynamometer.

RESULTS

Active discriminative touch had the strongest association with dexterity, explaining 46% of the variance. When spasticity and grip strength were added, the explained variance increased to 57% in the final multivariate model.

CONCLUSIONS

This study indicates that sensory function in terms of active discriminative touch is a major contributing factor to dexterity in persons with mild to moderate stroke, whereas spasticity and grip strength may be of lesser importance.

LEVEL OF EVIDENCE

III.

The Effect of Kinesiology Taping on the Hemiplegic Shoulder Pain: A Randomized Controlled Trial

Objective

The purpose of the study was to explore the effect of kinesiology taping on hemiplegic shoulder pain (HSP) in terms of pain intensity, magnitude of subluxation, muscle activity, and active range of motion (AROM).

Design

Double-blind, placebo-controlled clinical trial.

Setting

the Rehabilitation Center of the West China Hospital.

Participants

Nineteen individuals suffering from HSP were recruited in this study.

Intervention

Patients were randomly assigned into the taping group or control group. The taping group received therapeutic kinesiology taping and conventional treatment, while the control group received placebo taping (applied without tension) and conventional treatment.

Main Outcome Measures

The shoulder pain intensity (numerical pain rating scale), magnitude of subluxation, muscle activity (measured by surface electromyography (sEMG)), and shoulder active range of movement (AROM) were assessed at the baseline, on the first day (immediately after taping) and 4 weeks after treatment (without taping).

Results

All patients completed the trials. There were no significant differences between groups at the baseline. The taping group showed immediate improvement on the first day after taping in terms of pain intensity, magnitude of subluxation, and muscle activity (p < 0.05), whereas no significant changes seen in the control group (p > 0.05). After 4 weeks of treatment, the taping group showed significant changes in pain intensity, magnitude of subluxation, muscle activity, and AROM (p < 0.05). And significant differences in pain intensity and muscle activity could be seen between the two groups (p < 0.05).

Conclusion

The results indicate that the kinesiology taping is effective in reducing the shoulder pain and subluxation and increasing muscle activity and AROM for patients with HSP after stroke.

Shoulder pain after stroke - experiences, consequences in daily life and effects of interventions: a qualitative study

PURPOSE

To describe experiences of shoulder pain after stroke, how pain affects daily life and perceived effects of interventions.

METHOD

A qualitative interview study including 13 community-dwelling persons (six women; median age 65 years) with persistent shoulder pain after stroke.

RESULTS

Three categories emerged from the content analysis. In "Multiple pain characteristics" an insidious pain onset was reported. The pain existed both day and night and could be located around the shoulder girdle but also have radiation to the arm and hand. An explanation of the pain was seldom given. In "Limitations caused by the pain" it was described how the pain negatively influenced personal care, household activities and leisure, but also could lead to emotional reactions. In "Multiple pain interventions with various effects" a variety of interventions were described. Self-management interventions with gentle movements were perceived most effective. A restraint attitude to pain medication due to side effects was reported.

CONCLUSIONS

Shoulder pain after stroke can lead to a variety of pain characteristics. As the pain is complex and may affect many important areas in a person's life, multidisciplinary rehabilitation interventions are important. Implications for rehabilitation Shoulder pain after stroke can lead to a variety of pain characteristics with radiation to the arm and hand Shoulder pain often influence personal care, household activities and leisure negatively, which may lead to emotional reactions Self-management interventions with gentle movements are perceived most effective As the shoulder pain after stroke is complex, interventions by a multidisciplinary team may be needed.

Upper limb function and functional independence in patients with shoulder pain after stroke

ABSTRACT Objective To examine the frequency of shoulder pain following stroke. Methods Stroke patient function was evaluated using the Functional Independence Measure (FIM) and Scale for Upper Limb Function in Stroke (SULFS). Function scores were examined and compared between the shoulder pain group (SPG) and the no shoulder pain group (No-SPG). Results A total of 58 patients, 22 women (37.9%), were included in this study. The mean patient age was 49.2±10.8 years and study evaluations were done 3.52±2.26 months after stroke. A total of 16 patients (27.6%) were in the SPG and 42 patients (72.4%) were in the No-SPG. The SPG scored significantly lower on the FIM (SPG: 91.06±14.65 vs. No-SPG 114.62 ± 2.27; p < 0.01) and SULFS (SPG median: 2 [range: 1-4], No-SPG median: 5 [range: 1-5]; p < 0.01) than the No-SPG. Conclusion Shoulder pain commonly occurs after stroke and is related to the affected upper limb function and functional independence in stroke patients.

Characteristics of neuromuscular control of the scapula after stroke: a first exploration

This study aimed to characterize scapular muscle timing in stroke patients with and without shoulder pain. Muscle activity of upper trapezius, lower trapezius, serratus anterior, infraspinatus, and anterior deltoid (AD) was measured (Delsys Trigno surface EMG system, USA) in 14 healthy controls (dominant side) and 30 stroke patients (hemiplegic side) of whom 10 had impingement-like shoulder pain. Participants performed 45° and full range anteflexion, in two load conditions. The impact of group, anteflexion height, load condition, and muscle was assessed for onset and offset of the different muscles relative to the onset and offset of AD, using a 3 (group) × 2 (height) × 2 (load) × 4 (muscle) mixed model design. Recruitment patterns were additionally described. Across all load conditions and groups, serratus anterior had a significantly earlier onset and, together with lower trapezius, a significantly later offset in 45° compared to full range anteflexion tasks (p < 0.001). In stroke patients without pain, lower trapezius had furthermore a significantly earlier onset in comparison to stroke patients with shoulder pain (all tasks, p = 0.04). Serratus anterior also showed a significantly earlier offset in stroke patients with shoulder pain in comparison to controls (p = 0.01) and stroke patients without pain (p < 0.001). Analysis of muscle recruitment patterns indicated that for full range tasks, stroke patients without pain used early and prolonged activity of infraspinatus. In stroke patients with shoulder pain, recruitment patterns were characterized by delayed activation and early inactivity of serratus anterior. These timing results can serve as a reference frame for scapular muscle timing post-stroke, and when designing upper limb treatment protocols and clinical guidelines for shoulder pain after stroke.