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Abstract
Background and purpose: Following a stroke, three-dimensional clavicular/scapular/humeral joint rotations may become restricted and contribute to post-stroke shoulder pain. This study examined whether a treatment group provided with current standard treatment plus the proposed “Three-dimensional Shoulder Pain Alignment” mobilization protocol demonstrated improved pain-free shoulder range, functional reach and sleep compared to a control group provided with standard treatment alone.
Methods: In this double-blinded parallel-group randomized control trial, treatment and control subjects with moderate/severe post-stroke upper extremity impairment and shoulder pain were treated 3x/week for 4 weeks. Outcome measures included changes in pain-free three-dimensional clavicular/scapular/humeral range (using computerized digitization), pain during sleep and functional reach (using the Pain Intensity-Numerical Rating Scale), and pain location/prognostic indicators (using the Chedoke-McMaster Stroke Assessment-Shoulder Pain Inventory).
Results: Compared to controls (n = 10) the treatment group (n = 10) demonstrated significantly improved three-dimensional clavicular/scapular/humeral pain-free range during shoulder flexion and abduction (p < 0.05; Hedges g > 0.80), large effect sizes for decreased pain during sleep and functional reach to the head and back (OR range: 5.44-21.00), and moderate effect size for improved pain/prognostic indicators (OR = 3.86).
Conclusions: The Three-Dimensional Shoulder Pain Alignment mobilization protocol significantly improved pain-free range of motion, functional reach and pain during sleep in shoulders with moderate/severe post-stroke upper-extremity impairment.
Although three-dimensional clavicular/scapular/humeral rotations are an essential component of normal pain-free shoulder range of motion, current guidelines for treatment of post-stroke shoulder pain only includes uni-dimensional mobilizations for joint alignment and pain management.
The Three-Dimensional Shoulder Pain Alignment (3D-SPA) mobilization protocol incorporates multi-dimensional mobilizations in various planes of shoulder movement.
The current study results demonstrate proof-of-concept regarding the 3D-SPA mobilization, and this approach should be considered as an alternative to the uni-dimensional mobilizations currently used in clinical treatment guidelines for post-stroke shoulder pain.
Implications for rehabilitation
Acknowledgements
It is with sincere gratitude that we would like to thank George Madapallimattam, Tapas Kumar, Alexis Pain, Alyssa Indira, Sandra Dixon, Janet Moorehead, Sabina Sabota, Crystal Pelusso, Angela Mitrovic, Koyo Usuba, Rachel Tavares, Bushra Bayan, Priyanka Sharma, Misha Bajwa, Paul van den Ende, Richard Loh and Mr. Rustom Minwalla for their volunteer support during the study protocol development, recruitment and data collection process. We would also sincerely like to thank all of the study participants and stroke survivors who inspired the development of this mobilization protocol and research study.
Disclosure statement
The granting agency was not involved in the study design, the collection/analysis/interpretation of data, the writing of the report, or in the decision to submit the manuscript for publication. The authors declare no other potential conflicts of interest.