title: A randomized controlled trial of strapping to prevent post-stroke shoulder pain.
abstract: OBJECTIVE
  To determine whether strapping the shoulder in hemiplegic stroke patients: (1) prevents the development, or reduces the severity, of shoulder pain, (2) preserves range of movement in the shoulder, and (3) improves the functional outcomes for the arm and patient overall.
  
  
  METHODS
  A prospective, randomized, single-blind controlled trial of shoulder strapping versus no strapping.
  
  
  METHODS
  Care of the elderly wards in a teaching hospital, Christchurch, New Zealand.
  
  
  METHODS
  All patients admitted with an acute hemiplegic stroke, who had persisting weakness of shoulder abduction.
  
  
  METHODS
  The treatment group had their affected shoulder strapped for six weeks from randomization in addition to standard physiotherapy.
  
  
  METHODS
  All subjects were assessed at entry (week 0), at end of the treatment phase (week 6) and two months later (week 14). A visual analogue scale (VAS) was used to assess shoulder pain severity whereas shoulder range of movement to the point of pain (SROMP) assessed passive range of movement and pain. Functional Independence Measure (FIM), Motor Assessment Scale (MAS) and Rankin Disability Index measured functional outcomes.
  
  
  RESULTS
  Ninety-eight subjects participated (49 strapped, 49 controls). Intention to treat analysis showed no significant difference in pain, range of movement or functional outcomes after the intervention phase or at the final assessment. However there were trends for less pain at six weeks (VAS, p = 0.11) and better final upper limb function (MAS, p = 0.16) in strapped patients. Skin reactions were uncommon (6.1%). The presence of neglect or sensory loss, but not subluxation, at baseline was independently associated with poor outcome. Range of movement was lost early (mean difference SROMP between hemiplegic and contralateral shoulders at baseline = 15.2 degrees (95% CI 10.9-19.5)) and continued throughout the study. Shoulder strapping did not alter the rate at which range of movement was lost.
  
  
  CONCLUSIONS
  No significant benefit with shoulder strapping was demonstrated and reasons for this are discussed. Range of movement in the hemiplegic shoulder is lost very early and any preventive treatments need to begin within the first 1-2 days after a stroke.
authors.affiliation: The Princess Margaret Hospital, Christchurch, New Zealand. carl.hanger@healthlinksouth.co.nz
authors.forename: H C
authors.initials: HC
authors.lastname: Hanger
authors.forename: P
authors.initials: P
authors.lastname: Whitewood
authors.forename: G
authors.initials: G
authors.lastname: Brown
authors.forename: M C
authors.initials: MC
authors.lastname: Ball
authors.forename: J
authors.initials: J
authors.lastname: Harper
authors.forename: R
authors.initials: R
authors.lastname: Cox
authors.forename: R
authors.initials: R
authors.lastname: Sainsbury
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006429:Hemiplegia / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020069:Shoulder Pain / Q000503:physiopathology / Q000534:rehabilitation*; D016037:Single-Blind Method; D013165:Splints; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome