Hemiplegic Shoulder Pain: Studies of Epidemiology, Assessment and Management

Author: Zoe Adey-Wakeling

Adey-Wakeling, Zoe, 2016 Hemiplegic Shoulder Pain: Studies of Epidemiology, Assessment and Management, Flinders University, School of Health Sciences

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Rehabilitation focuses on maximising an individual’s independence following disease or disability. With increasing survival following stroke, there is a growing rehabilitation population of patients with stroke-related disability. Whilst increasing attention has been directed towards motor deficits such as upper limb weakness following stroke, the common complications of such deficits such as shoulder pain are often overlooked.

Hemiplegic shoulder pain is a common complication of stroke, and the focus of this thesis. This thesis explores the current literature pertaining to this topic: its context within the broader upper limb deficits post stroke (Publication 1), its definition, aetiology and evidence for prophylaxis and treatment. Building on this background, original research using data from a population based stroke incidence study then provides information on the local epidemiology, and the typical characteristics of shoulder pain presentation (Publication 2). A greater understanding of typical presentations provides the clinician with context and understanding on which to build strategies for assessment and treatment.

Randomised controlled data provides insight into suprascapular nerve block as an evidence-based treatment option. The protocol paper (Publication 3) outlines the rationale for investigating this intervention, with the randomised controlled trial providing evidence on efficacy and effectiveness (Publication 4). Post-hoc analysis (Publication 5) provides information on selecting patients who are likely to respond to this intervention. This pragmatic trial provides information which is highly relevant to patients under the care of all Australian rehabilitation units but the findings are generalizable to all stroke patients with hemiplegic shoulder pain.

Whilst the experience of stroke and pain after stroke have previously been shown to impact on quality of life, the specific impact of hemiplegic shoulder pain has not been demonstrated. Using data from the population study on stroke the impact of hemiplegic shoulder pain occurring at any time during the first year after stroke on health-related quality of life is demonstrated (Publication 6).

The findings of this thesis suggest that a new approach to the assessment and management of shoulder pain after stroke could be considered and tested. A possible protocol is suggested for future evaluation. The gap between research and implementation in clinical practice is well known and a review of possible barriers and facilitators to knowledge translation is discussed.

Hemiplegic shoulder pain after stroke affects more than one in four stroke survivors. Greater understanding of this common complication of stroke will enhance the clinical focus on appropriate evidence-based management options.

Keywords: Stroke, shoulder, pain, epidemiology

Subject: Rehabilitation thesis

Thesis type: Doctor of Philosophy
Completed: 2016
School: School of Health Sciences
Supervisor: Professor Maria Crotty