Assessment of shoulder pain in hemiplegia: sensitivity of the ShoulderQ

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.     

Hemiplegic shoulder pain (HSP): Natural history and investigation of associated features

The prevalence of hemiplegic shoulder pain (HSP) and associated factors was studied in patients with a stroke followed for 6 months after discharge from hospital. A questionnaire was used to evaluate shoulder symptoms and an examination of the shoulder and arm was carried out three times over 6 months. A total of 108 patients were studied with a mean age of 71 years. Sixty-nine patients (63.8%) developed HSP at some time during the study period. The number with HSP was 39 at discharge from hospital, 59 at 8 weeks post-discharge and 36 at 6 months. Nine carers reported lifting the patient by pulling on the hemiplegic arm, even though six of them had received advice about correct lifting techniques. Reduced shoulder shrug was associated with HSP at all times and reduced pinch grip was also associated with HSP at discharge from hospital. Patients who required help with transfers were more likely to suffer with HSP. There was no difference in the prevalence of HSP in patients treated at the day hospital compared to those who received domiciliary physiotherapy. It is concluded that HSP is common after a stroke and the prevalence increases in the first weeks after discharge from hospital. Stroke patients and their carers need advice about correct handling of the hemiplegic arm, and more work is required to ensure that correct handling occurs after discharge in patients at high risk of this unpleasant complication.     

偏瘫肩痛患者肩胛肌肉的表面肌电特征研究

目的:应用表面肌电技术探讨偏瘫肩痛患者在上肢特定功能动作中肩胛肌肉的表面肌电特征。方法:选取2019年1月至2019年6月在无锡市同仁康复医院住院的脑卒中后偏瘫肩痛者21例作为偏瘫肩痛试验组(HSP组);年龄、性别以及其他因素与HSP组相匹配的健康志愿者22例为健康对照组。应用表面肌电技术记录HSP组患侧和对照组利手侧上斜方肌(upper trapezius,UT)、中斜方肌(middle trapezius,MT)、下斜方肌(lower trapezius,LT)和前锯肌(serratus anterior,SA)在最大等长收缩(MVIC)以及"够物"动作中的表面肌电信号,原始信号经处理后对比分析肌电特征,包括目标肌肉激活水平(MVIC%)和激活比率(UT/LT、UT/SA、MT/SA)。结果:(1)比较"够物"动作过程中各目标肌肉激活水平:HSP组UT激活水平(MVIC%)大于健康对照组,具有显著差异(P0.01);SA和LT激活水平明显小于对照组(P0.01);两组之间MT的MVIC%值无显著性差异(P0.05)。(2)各目标肌肉的在"够物"过程中UT/LT、UT/SA、MT/SA激活比率情况对比:HSP组的UT/LT、UT/SA、MT/SA的激活比率均高于健康对照组(P0.05)。结论:偏瘫肩痛患者在够物过程中表面肌电存在异常特征性改变。在运动学上,表面肌电用于评估该类患者肩胛骨的运动具有相当可行性,可定量评估其运动功能障碍并为临床康复治疗提供客观指导。     

脑卒中患者偏瘫肩痛症状的质性研究

目的探索脑卒中患者偏瘫肩痛症状的真实体验、影响因素及症状结局。方法选取2016年3—6月于上海市阳光康复中心住院的16例脑卒中后偏瘫肩痛患者,采用描述性质性研究方法进行半结构式访谈,并以Colaizzi七步分析法分析资料。结果研究提炼出四大主题:患者对于偏瘫肩痛的认识不足、偏瘫肩痛症状体验呈多样性、偏瘫肩痛影响因素复杂、偏瘫肩痛后果严重。结论脑卒中患者对偏瘫肩痛症状认识片面、对症状的关注普遍缺乏,医务人员进行症状管理时应避免偏瘫肩痛诱因和加重因素,及时为患者提供信息支持并积极处理疼痛,提高其对症状的自我管理能力。     

A preliminary economic evaluation of percutaneous neuromuscular electrical stimulation in the treatment of hemiplegic shoulder pain

Objective. The objective of this study was to compare the cost-effectiveness of various treatment modalities for hemiplegic shoulder pain.

Design. A stage II economic evaluation.

Main outcome measures. Incremental cost effectiveness ratio of P-NMES, compared to slings and anti-inflammatory injections.

Results. The incremental cost effectiveness ratio (ICER) of p-NMES, compared to anti-inflammatory injections is €6,061 (±3,285). The incremental cost of the first quality-adjusted life year after implantation of the P-NMES device compared to anti-inflammatory injections is €33,007 (±5,434). This decreases to ≈ €7,000 after 5 years, and to ≈ €5,000 after 10 survival years.

Conclusion. In this early evaluation, P-NMES seems to be cost-effective according to known guidelines. Treatment with P-NMES is recommended for patients with chronic HSP.     

器械辅助软组织松解技术对于偏瘫肩痛的疗效观察

目的:研究器械辅助软组织松解技术(IASTM)对于偏瘫肩痛(HSP)患者的疗效观察。方法:将HSP患者43例随机分为观察组23例和对照组20例。2组均采用常规个体化康复治疗,观察组加用IASTM对肩周软组织进行治疗,对照组给予手法治疗,共治疗4周。治疗前后评估上肢运动功能采用上肢简化Fugl-Meyer量表评分(FMA-UE)评估,肩关节被动活动度(PROM)采用通用量角器进行测量评估,疼痛采用视觉模拟评分法(VAS)进行评估,日常生活活动能力采用改良Barthel指数(MBI)评估。结果:治疗前,2组患者FMA-UE评分、肩关节PROM、VAS评分以及MBI评分比较均无显著差异,治疗4周后,2组FMA-UE评分、肩关节PROM及MBI评分均较治疗前明显提高(P<0.05),且观察组均优于对照组(P<0.05)。2组VAS评分均较治疗前明显降低(P<0.05),且观察组低于对照组(P<0.05)。结论:IASTM和手法治疗均能改善患者上肢运动功能,PROM,疼痛程度以及ADL能力,且IASTM对HSP患者的改善效果要优于手法治疗。     

A preliminary economic evaluation of percutaneous neuromuscular electrical stimulation in the treatment of hemiplegic shoulder pain

Objective. The objective of this study was to compare the cost-effectiveness of various treatment modalities for hemiplegic shoulder pain.

Design. A stage II economic evaluation.

Main outcome measures. Incremental cost effectiveness ratio of P-NMES, compared to slings and anti-inflammatory injections.

Results. The incremental cost effectiveness ratio (ICER) of p-NMES, compared to anti-inflammatory injections is €6,061 (±3,285). The incremental cost of the first quality-adjusted life year after implantation of the P-NMES device compared to anti-inflammatory injections is €33,007 (±5,434). This decreases to ≈ €7,000 after 5 years, and to ≈ €5,000 after 10 survival years.

Conclusion. In this early evaluation, P-NMES seems to be cost-effective according to known guidelines. Treatment with P-NMES is recommended for patients with chronic HSP.     

Bobath技术在脑卒中偏瘫肩痛患者早期康复护理干预中的应用

目的:探讨Bobath技术在早期康复护理干预脑卒中偏瘫患者中对肩痛二级预防的影响。方法:将68例偏瘫患者随机分为干预组和对照组各34例,对照组给予神经内科常规治疗与护理,干预组在此基础上给予Bobath技术早期康复护理干预。比较两组干预前后Fugl-Meyer上肢运动功能评价法(U-FMA)、Barthel指数(BI)、视觉模拟评分法(VAS)。结果:两组干预后U-FMA、BI均优于干预前(P0.05),干预组干预后U-FMA、BI、VAS优于对照组(P0.05)。结论:运用Bobath技术的早期康复护理干预优于一般常规护理,可有效预防脑卒中偏瘫肩痛,提高上肢运动功能水平及日常生活活动能力。     

偏瘫肩痛对上肢功能恢复的影响

目的:探讨偏瘫肩痛对上肢功能恢复的影响和防治偏瘫肩痛的有效治疗方法。方法:100例脑卒中偏瘫患者随机分成康复组(50例)和对照组(50例)进行临床对照研究,两组均常规进行神经内科药物治疗,康复组加以运动疗法等综合康复治疗,并对每组患者在入组时和6个月后利用Fugl-Meyer评定量表上肢部分进行功能评定。结果:康复肩痛组两次上肢功能评分分别为23.55±2.12、37.36±2.55(P<0.05);对照肩痛组为24.36±2.54、26.37±2.51(P>0.05),非肩痛组为25.34±2.44、48.67±2.41(P<0.05);25.78±2.31、40.11±3.30(P<0.05),入组时评分各组之间差异无显著性意义(P>0.05),6个月后肩痛组和非肩痛组之间差异有显著性意义(P<0.05),以及康复肩痛组和对照肩痛组之间差异有显著意义(P<0.05)。结论:肩痛的出现严重阻碍了上肢功能的恢复,规范化三级康复治疗能有效地防治偏瘫肩痛。     

肩胛控制训练对预防和治疗偏瘫患者肩痛的作用

目的探讨肩胛的控制训练对偏瘫患者肩痛预防和治疗的意义。方法按脑血管病诊断标准将65例偏瘫患者随机分成两组对照组30例按常规方法进行康复训练;训练组35例在常规训练的基础上强调肩胛骨的控制训练。训练时间为1－4个月(平均71天)。结果训练组肩痛发生率比对照组低(P＜0.01);训练组的肩痛改善率比对照组高(P＜0.01);两组上肢功能Fugl-Meye得分均有提高,训练组比对照组提高明显(P＜0.01)。结论肩胛骨的控制训练对偏瘫患者肩痛的预防和治疗有重要意义。     

刺络拔罐配合康复训练治疗偏瘫肩痛26例的对照观察

目的观察刺络拔罐配合康复训练治疗偏瘫肩痛的疗效.方法将56例偏瘫肩痛患者随机分成2组,其中治疗组26例,采用刺络拔罐配合康复训练治疗,对照组30例采用单纯康复训练治疗,对2组肩痛程度和频度,以及上肢Brunnstrom分级进行组间及自身前后对照.结果治疗后两组户痛程度和频度积分均低于治疗前(P<0.01),两组间差值比较有统计学意义(P<0.05),治疗组优于对照组.治疗组偏瘫患者上肢运动功能达Ⅵ级以上的由15.4%提高到65.4%,高于对照组的56.7%.结论刺络拨罐配合康复训练是一种治疗偏瘫肩痛的较好方法.     

超声引导下肩峰下滑囊类固醇注射联合神经肌肉电刺激治疗偏瘫肩痛的随机对照研究

目的:研究超声引导下肩峰下滑囊类固醇注射联合神经肌肉电刺激治疗对脑卒中偏瘫后肩痛的影响。方法:选择偏瘫肩痛的患者为研究对象,随机分为观察组和对照组,每组各30例,两组均给予常规康复,对照组给予肩峰下滑囊注射类固醇注射治疗,观察组在对照组基础上增加神经肌肉电刺激疗法。在治疗前、治疗后第1个月、3个月时对所有患者进行视觉模拟评量表(VAS)评分、被动肩关节活动度(PROM)、Fugl-Meyer(FMA)上肢功能评分及改良Barthel指数(MBI)评分。结果:治疗前两组患者一般人口学特征无显著性差异,就病程、年龄和治疗前指标而言,两组具有可比性(P>0.05)。两组患者治疗前后VAS评分、Fugl-Meyer上肢功能评分、PROM及MBI比较,均具有显著性差异(P<0.01)。观察组治疗后各时间点肩关节活动度(尤其外展和外旋)角度、Fugl-Meyer上肢功能评分、MBI评分均高于对照组(P<0.01);而VAS评分均低于对照组,有显著性意义(P<0.01)。结论:超声引导下肩峰下滑囊类固醇注射联合神经肌肉电刺激治疗偏瘫肩痛能够有效缓解患者的肩痛症状,改善上肢运动功能,提高日常生活能力。     

针刺配合康复训练治疗偏瘫肩痛的疗效观察

目的观察针刺配合康复训练治疗偏瘫肩痛的疗效。方法将 10 0例偏瘫肩痛患者随机分为两组 ,治疗组 5 0例采用针刺配合康复训练 ,对照组 5 0例采用单纯康复训练 ;对两组的疗效进行组间及组内对照分析。结果治疗后 ,两组患者的肩痛程度积分低于治疗前 (P <0 .0 1) ,上肢运动功能达IV级以上者明显增多 (P <0 .0 1) ,但治疗组均优于对照组 (P <0 .0 5 )。结论针刺配合康复训练能有效提高偏瘫肩痛的治疗效果。     

Reliability and relationship of the fear-avoidance beliefs questionnaire with the shoulder pain and disability index and numeric pain rating scale in patients with shoulder pain

Purpose: The purpose of this study was to determine: 1) the test–retest reliability of Fear-Avoidance Beliefs Questionnaire (FABQ) Work (FABQW) subscale, FABQ Physical Activity (FABQPA) subscale, Shoulder Pain and Disability Index (SPADI) Pain subscale, SPADI Disability subscale, and Numeric Pain Rating scale (NPRS); and 2) the relationship between the FABQPA, FABQW, SPADI pain, SPADI disability, and NPRS after 4 weeks of pragmatically applied physical therapy (PT) in patients with shoulder pain. Design: Prospective, single-group observational design. Methods: Data were collected at initial evaluation, the first follow-up visit prior to the initiation of treatment, and after 4 weeks of treatment. Results: Statistically significant Intraclass Correlation Coefficient (ICC_2,1) values were reported for the FABQPA, FABQW, SPADI Pain, SPADI Disability, and NPRS. A statistically significant moderate relationship between the FABQPA subscale, SPADI subscale, and NPRS could not be established prior to and after 4 weeks of pragmatically applied PT. Statistically significant differences were observed between the initial evaluation and four-week follow-up for the FABQPA, SPADI Pain, SPADI Disability, and NPRS (p < 0.01). Discussion: Since a meaningful relationship between the FABQ, SPADI, and NPRS did not exist, it suggests that the FABQPA may be measuring a metric other than pain. Conclusions: This study suggests that the FABQW may not be sensitive to change over time.     

针灸治疗脑卒中后偏瘫颈肩痛的临床效果

目的 探讨针灸治疗脑卒中后偏瘫颈肩痛的临床效果。方法 选取2018年5月至2020年5月本院200例脑卒中后偏瘫颈肩痛患者作为研究对象,按照随机数字表法将其分为对照组和观察组,各100例。对照组给予常规西药治疗,观察组在对照组基础上给予针灸治疗。比较两组患者的神经功能、疼痛程度、肢体功能、临床疗效。结果 治疗前,两组的NFDS、VAS评分比较,差异无统计学意义（P>0.05）;治疗后,两组的NFDS、VAS评分均较治疗前降低,且观察组低于对照组,差异具有统计学意义（P<0.05）。治疗前,两组的上肢功能、下肢功能评分比较,差异无统计学意义（P>0.05）;治疗后,两组的上肢功能、下肢功能评分均较治疗前升高,且观察组高于对照组,差异具有统计学意义（P<0.05）。观察组的治疗总有效率为94.00%,高于对照组的81.00%,差异具有统计学意义（P<0.05）。结论 针灸治疗脑卒中后偏瘫颈肩痛的效果显著,可改善患者的神经功能及肢体功能,缓解疼痛程度,值得临床推广应用。     

卒中后偏瘫肩痛患者肩周组织超声影像特点

目的:本研究拟通过对脑卒中后偏瘫肩痛患者进行肩关节超声检查,观察卒中后偏瘫患者肩关节及其周围组织的超声影像特点,为偏瘫肩痛患者个体化临床治疗提供客观依据。方法:2016年10月—2017年4月,随机纳入在中山大学附属第三医院康复科住院的31例偏瘫患者进行研究,根据NAS评分将所有患者分为肩痛组和非肩痛组,所有患者双侧肩关节均进行超声检查。体格检查包括肩关节被动关节活动度、Fugl-Meyer上肢功能评定、内收内旋肌群肌张力等。结果:患者肩关节半脱位发生率:肩痛组高于非肩痛组(81.3%vs 40.0%,P=0.018)。肩痛组患者肩胛下肌-喙突滑囊粘连(81.3%)、肩峰下撞击征(75.0%)和肩峰-三角肌下滑囊病变(56.3%)的发生率均显著高于非肩痛组,组间差异有显著性意义(P0.05)。结论:本研究中,卒中后偏瘫肩痛患者的肩关节半脱位、肩胛下肌-喙突滑囊粘连、肩峰下撞击征及肩峰-三角肌下滑囊炎发生率显著高于非肩痛患者。超声影像可明确卒中后偏瘫肩痛患者肩关节及其周围软组织病变,有助于明确导致卒中后肩痛的可能原因,为卒中后肩痛患者的个体化临床治疗提供参考依据。     

Poststroke shoulder pain: a prospective study of the association and risk factors in 152 patients from a consecutive cohort of 205 patients presenting with stroke.

BACKGROUND AND PURPOSE: Shoulder pain is known to retard rehabilitation after stroke. Its causes and prognosis are uncertain. This study describes the incidence of poststroke shoulder pain prospectively, in an unselected stroke population in the first 6 months after stroke and identifies risk factors for developing pain. METHODS: 297 patients with possible stroke were screened and stroke diagnosed in 205 cases. The 152 patients entered the study of which 123 patients were assessed up to 6 months. This cohort, with a mean age of 70.6 years, was examined at 2 weeks, 2, 4, and 6 months. A history of shoulder pain, Barthel score, anxiety and depression score were recorded. Full neurological and rheumatological examination was undertaken, using the contralateral side as a control. Pain outcome and stroke outcome was recorded at subsequent visits. RESULTS: 52 (40%) patients developed shoulder pain on the same side of their stroke. There was a strong association between pain and abnormal shoulder joint examination, ipsilateral sensory abnormalities and arm weakness. Shoulder pain had resolved or improved at 6 months in 41 (80%) of the patients with standard current treatment. CONCLUSIONS: Shoulder pain after stroke occurred in 40% of 123 patients surviving, consenting and not too unwell to participate. This included 52 patients of an original cohort of 205 patients presenting with stroke. Eighty percent of patients made a good recovery with standard treatment Patients with sensory and or motor deficits represent at risk sub-groups.