Treatment of hemiplegic shoulder pain in the Netherlands: results of a national survey.
OBJECTIVE
To describe the methods of treatment applied by physiotherapists, occupational therapists, rehabilitation physicians, nursing-home physicians and neurologists for hemiplegic shoulder pain, and to investigate their beliefs about the effectiveness of triamcinolone acetonide injections for this diagnosis.


METHODS
Postal questionnaire with structured and open-ended questions. If necessary, a written reminder was sent after 2-3 weeks.


METHODS
One hundred physiotherapists, 100 occupational therapists, 100 rehabilitation physicians, 100 nursing-home physicians and 100 neurologists in the Netherlands. These healthcare workers were all active in the rehabilitation of stroke patients.


RESULTS
The response was 351 (70.2%), ranging from 58% (neurologists) to 83% (physiotherapists). Fifty-four different (combinations of) treatments were mentioned and were classified into eight treatment groups. The frequency of the first choice of treatment was: physiotherapy (32%), prevention/instruction/education (22%), oral medication (8%), local injection (7%), sling (4%), referral (3%), other therapies (4%), and different combinations (20%). In total, 86 respondents had applied local injections: 70 rehabilitation physicians, 10 nursing-home physicians and 6 neurologists. The injections used were: corticosteroids alone (51.2%), in combination with a local anaesthetic (37.2%) or a local anaesthetic only (9.3%). Belief in the effectiveness of triamcinolone injections, measured on a 0-100 point scale, was: physiotherapists median 62.5 (IQR 29.75-71.75), occupational therapists median 50.0 (IQR 43.0-63.0), rehabilitation physicians median 70.0 (IQR 56.5-80.0), nursing-home physicians median 35.0 (IQR 21.0-64.5), neurologists median 47.0 (IQR 20.0-63.0).


CONCLUSIONS
As preventive measures and physiotherapy, or a combination of both, were found to be the favourite methods of treatment for hemiplegic shoulder pain in this survey, it seems that most physicians and therapists rely on a mechanical approach to hemiplegic shoulder pain. Rehabilitation physicians used additional local (anti-inflammatory) injections.
Snels
I A
IA
Department of Rehabilitation Medicine, University Hospital, Vrije Universiteit, and Institute for Research in Extramural Medicine, Amsterdam, The Netherlands. i.snels@azvu.nl
Beckerman
H
H
Lankhorst
G J
GJ
Bouter
L M
LM
D000328:Adult; D003625:Data Collection; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006282:Health Personnel; D006429:Hemiplegia / Q000150:complications*; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D026741:Physical Therapy Modalities; D020069:Shoulder Pain / Q000209:etiology / Q000628:therapy*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide