Incidence and potential predictors of early onset of upper-limb contractures after stroke

Abstract

Objectives

To investigate the incidence and potential predictors of upper-limb contractures, three months after stroke.

Design

Prospective cohort study.

Methods

Consecutive sample of individuals with hemiparesis due to stroke, admitted to a public hospital in Brazil. Contractures were measured by passive range of motion of lateral shoulder rotation, elbow extension, and wrist extension with a gravity inclinometer. Potential predictors included measures of muscle strength, spasticity of the upper-limb muscles, upper-limb function, dexterity, and pain. Measurements were obtained within four weeks and at three months after the stroke. A binomial regression analysis was employed.

Results

Out of the 76 individuals with hemiparesis, 28% developed at least one contracture on their paretic upper limb. The incidence of contracture varied across the joints from 6% to 16% and the wrist was the most affected joint. Individuals with moderate stroke showed higher incidence of contracture, compared with those with mild stroke. Dexterity (OR 0.009, 95% confidence intervals (95% CI) 0.00–0.19) and pain (OR 6.417, 95% CI 1.22–33.83) were significant predictors of shoulder, elbow, and wrist contractures.

Conclusions

Individuals with mild and moderate stroke developed upper-limb contractures three months after the onset of the stroke, with an incidence of 28%. The predictors were the presence of pain and loss of dexterity. These impairments should be earlier targeted during rehabilitation interventions.

Implications for rehabilitation

• The incidence of upper limb contracture 3 months after the stroke is high after mild to moderate stroke.

• Wrist contractures are the most common upper limb contracture.

• The presence of pain and loss of dexterity significantly contribute to the development of upper limb contractures.

• Health professionals should target on the control of pain and improvement of upper-limb dexterity to prevent contractures.

Keywords:

• Contracture
• stroke
• dexterity
• pain
• incidence

Disclosure statement

There was no conflict of interest.