Background: Shoulder pain after stroke is common and disabling. The optimal management is uncertain, but electrical stimulation (ES) is often used to treat and prevent pain.
Objectives: The objective of this review was to determine the efficacy of any form of surface ES in the prevention and/or treatment of pain around the shoulder at any time after stroke.
Search strategy: We searched the Cochrane Stroke Review Group trials register and undertook further searches of Medline, Embase and CINAHL. Contact was established with equipment manufacturers and centres that have published on the topic of ES.
Selection criteria: We considered all randomized trials that assessed any surface ES technique (functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS) or other), applied at any time since stroke for the purpose of prevention or treatment of shoulder pain.
Data collection and analysis: Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data.
Main results: Four trials (a total of 170 subjects) fitted the inclusion criteria. Study design and ES technique varied considerably, often precluding the combination of studies. Population numbers were small. There was no significant change in pain incidence (odds ratio (OR) 0.64; 95% CI 0.19–2.14) or change in pain intensity (standardized mean difference (SMD) 0.13; 95% CI –1.0–1.25) after ES treatment compared with control. There was a significant treatment effect in favour of ES for improvement in pain-free range of passive humeral lateral rotation (weighted mean difference (WMD) 9.17; 95% CI 1.43–16.91). In these studies ES reduced the severity of glenohumeral subluxation (SMD –1.13; 95% CI –1.66 to –0.60), but there was no significant effect on upper limb motor recovery (SMD 0.24; 95% CI –0.14–0.62) or upper limb spasticity (WMD 0.05; 95% CI –0.28–0.37). There did not appear to be any negative effects of electrical stimulation at the shoulder.
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References
1.
Roy C, Sands M, Hill L. Shoulder pain in acutely admitted hemiplegics. Clin Rehabil1994; 8: 334–340.
2.
Van Ouwenaller C, Laplace P, Chantraine A. Painful shoulder in hemiplegia. Arch Phys Med Rehabil1986; 6: 22–36.
3.
Wanklyn P, Forster A, Young J. Hemiplegic shoulder pain (HSP): natural history and investigation of associated features. Disabil Rehabil1996; 18(10): 497–501.
4.
Roy CW, Sands MR, Hill LD, Harrison A, Marshall S. The effect of shoulder pain on outcome of acute hemiplegia. Clin Rehabil1995; 9: 21–27.
5.
Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS. Recovery of upper extremity function in stroke patients: the Copenhagen stroke study. Arch Phys Med Rehabil1994; 75: 394–398.
6.
Gowland C. Recovery of motor function following stroke: profile and predictors. Physiother Can1982; 34(2): 77–84.
7.
Wyller TB, Sveen U, Sodring KM, Pettersen Bautz-Holter E. Subjective well-being one year after stroke. Clin Rehabil1997; 11: 139–145.
8.
Bohannon RW, Larkin PA, Smith MB, Horton MG. Shoulder pain in hemiplegia: statistical relationship with five variable. Arch Phys Med Rehabil1986; 67: 514–516.
9.
De Courval LP, Barsaukas A, Berenbaum B et al. Painful shoulder in the hemiplegic and unilateral neglect. Arch Med Phys Rehabil1990; 71: 673–676.
10.
Zorowitz R, Hughes M. Shoulder pain and subluxation after stroke: coincidence?Am J Occup Ther1996; 50(3): 194–201.
11.
Liberson WT, Holmquest HJ, Scot D, Dow M. Functional electrotherapy: stimulation of the peroneal nerve synchronised with the swing phase of the gait of hemiplegic patients. Arch Phys Med Rehabil1961; 42: 101–105.
12.
Albert A, Andre JM. State of the art of functional electrical stimulation in France. Int Rehabil Med1984; 6:13–18.
13.
Dimitriijevic MM, Soroker N. Mesh-glove: 2. Modulation of residual upper limb motor control after stroke with whole-hand electric stimulation. Scand J Rehabil Med1994; 26: 187–190.
14.
Kumar VP, Lau HK, Lui J, Pereira BP, Phjo RW. Clinical applications of functional electrical stimulation. Ann Acad Med Singapore1995; 24(3): 428–435.
15.
Faghri PD. The effects of neuromuscular stimulation-induced muscle contraction versus elevation on hand oedema in CVA patients. J Hand Ther1997; 10(1): 29–24.
16.
Faghri PD, Rodgers MM, Glaser RM, Bors JG, Ho C, Akuthota P. The effects of functional electrical stimulation on shoulder subluxation, arm function recovery and shoulder pain in hemiplegic stroke patients. Arch Phys Med Rehabil1994; 75: 73–79.
17.
Baker LL, Parker K. Neuromuscular electrical stimulation of the muscles surrounding the shoulder. Phys Ther1986; 66(12): 1930–1937.
18.
Prada G, Tallis R. Treatment of the neglect syndrome in stroke patients using a contingency electrical stimulator. Clin Rehabil1995; 9: 304–313.
19.
Pandyan AD, Granat MH, Stott DJ. Effects of electrical stimulation on flexion contractures in the hemiplegic wrist. Clin Rehabil1997; 11: 123–130.
20.
Leandri M, Parodi CI, Corrieri N, Rigardo S. Comparison of TENS treatments in hemiplegic shoulder pain. Scand J Rehabil Med1990; 22(2): 69–71.
21.
Potisk KP, Gregoric M, Vodovnik L. Effects of transcutaneous electrical nerve stimulation (TENS) on spasticity in patients with hemiplegia. Scand J Rehabil Med1995; 27: 169–174.
22.
Glanz M, Klawansky S, Stason W, Berkley C, Chalmers TC. Functional electrostimulation in post-stroke rehabilitation: a meta-analysis of the randomised controlled trials. Arch Phys Med Rehabil1996; 77(6): 549–553.
23.
Binder-Macleod SA, Lee SCK. Assessment of the efficacy of functional electrical stimulation in patients with hemiplegia. Top Stroke Rehabil1997; 3(4): 88–98.
Price DD, Bush FM, Long S, Harkins SW. A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain1994; 56: 217–226.
26.
Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheumatic Dis1978; 37: 378–381.
27.
Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain1975; 1: 277–299.
28.
Price CIM, Curless RH, Rodgers H. Can stroke patients use visual analogue scales?Stroke1999; 30: 1357–1361.
29.
Linn SL, Granat MH, Lees KR. Prevention of shoulder subluxation after stroke with electrical stimulation. Stroke1999; 30: 963–968.
30.
Sonde L, Gip C, Fernaeus SE, Nilsson CG, Viitanen M. Stimulation with low frequency (1.7Hz) transcutaneous electric nerve stimulation (low-TENS) increases motor function of the post-stroke paretic arm. Scand J Rehabil Med1998; 30: 95-99.
31.
Chantraine A, Baribeault A, Uebelhart D, Gremion G. Shoulder pain and dysfunction in hemiplegia: effects of functional electrical stimulation. Arch Phys Med Rehabil1999; 80: 328-331.
32.
Chantraine A, Frischknecht R, Gremion G. Shoulder electrical stimulation in hemiplegic patients. Eur J Neurol1996; 3(suppl 2): 9-9.
33.
Pandyan AD, Price CIM, Curless RH, Johnson GR, Barnes MP, Rodgers H. A review of the properties and limitations of the Ashworth and Modified Ashworth Scales as measures of spasticity. Clin Rehabil1999; 13: 373-383.
34.
Feys H, De Weerdt W, Selz B et al. Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single blind randomized controlled multicentre trial. Stroke1998; 29: 785-792.
35.
Parry RH, Lincoln NB, Vass CD. Effect of severity of arm impairment on repsonse to additional physiotherapy early after stroke. Clin Rehabil1999; 13: 187-198.
