Assessment of shoulder pain in hemiplegia: Sensitivity of the ShoulderQ

Abstract

Background. The ShoulderQ is a structured questionnaire designed to assess timing and severity of hemiplegic shoulder pain (HSP), in order to target pain relief effectively. It includes both verbal and visual graphic rating scale questions, simply presented for patients with language/visuo-spatial deficits following stroke.

Objective. To assess the sensitivity of the ShoulderQ to clinical improvement in shoulder pain following multi-disciplinary intervention.

Design and setting. Retrospective analysis of serial questionnaires collected in the course of clinical treatment in an in-patient neurological rehabilitation unit.

Subjects and interventions. Thirty consecutive adults with cognitive and communicative deficits, presenting with hemiplegic shoulder pain following acquired brain injury. Multi-disciplinary treatment was delivered through an integrated care pathway, and ShoulderQs recorded fortnightly, including at baseline and end of treatment.

Results. Changes on visual graphic rating scale (VGRS) were associated with verbal reports of improvement (rho 0.665, p < 0.001). Patients were divided retrospectively on the basis of their overall clinical response into responders (n = 18) and non-responders (n = 12). Responders showed significant change in both VGRS and verbal scores, whereas the non-responder group did not. A change in summed VGRS score of ≥3 showed 77% sensitivity and 91.3% specificity for identifying the responders, with a positive predictive value of 93.3%. Summed VGRS scores of ≤2 had a negative predictive value of 73.3%.

Conclusion. In this preliminary evaluation of clinical data, the ShoulderQ appears to provide a sensitive measure of shoulder pain which is responsive to change in pain experience for those able to complete the questionnaire, despite the difficulties that many of this group of patients may have in reporting their symptoms. Set alongside previously reported test-retest reliability, the results support the utility of the ShoulderQ as a simple and practical tool for evaluation of shoulder pain in patients with severe complex disabilities.

Keywords:

• Rehabilitation
• integrated care pathway
• hemiplegic shoulder pain
• pain assessment

Notes

¹ Simple visual analogue scales (VAS) were used in the original version of the ShoulderQ, but subsequent evaluation has demonstrated that numbered visual graphic rating scales (VGRS) improve the test-retest reliability, so these have now replaced VAS scales in the current version of the ShoulderQ and AbilityQ.